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Crucial Steps to Take NOW for Sexual Abuse and Molestation (SAM) Safety in Healthcare

When we think of healthcare, we usually picture doctors, nurses and other medical professionals working hard to improve our health. But there’s a critical aspect of healthcare that often gets overlooked: patient safety, particularly when it comes to maintaining emotional and physical boundaries. This is especially important in preventing sexual abuse and molestation (SAM) in healthcare settings.

Unfortunately, healthcare spaces can sometimes become places where vulnerable patients are at risk. That’s why it’s crucial for healthcare systems, providers and organizations to take proactive steps to protect patients from any form of sexual abuse or exploitation.

In this article, we’ll explore five key actions healthcare providers must take right now to ensure patient safety and prevent SAM incidents. These steps not only protect patients but also help safeguard healthcare providers, fostering a culture of trust, transparency and professionalism across the organization.

This article is part of OmniSure’s series on 25 Trends in Risk Management for 2025. Here, we dive into the first of five important issues, focusing on how the healthcare industry can tackle SAM and improve patient safety in the year to come. As the healthcare landscape evolves, making SAM prevention a top priority is more important than ever.

Trend 1 — Making Patient Advocates the Standard of Care in Healthcare

To truly protect patients, especially during sensitive medical procedures, healthcare must undergo a major shift. One of the most important changes we can make is to ensure patient advocates become a standard part of the care process. But what does that really mean, and why is it so critical? Let’s break it down and explore how integrating patient advocates can help create a safer and more respectful healthcare environment.

What Is a Patient Advocate?

A patient advocate is another term for “chaperone” and refers to someone present during intimate/sensitive exams, but the role of a professional patient advocate for the purposes of a sensitive exam goes much further than that. A professional patient advocate is a neutral third party whose main job is to ensure the patient’s rights, dignity and safety are always respected, while also supporting the healthcare professional. The term ‘patient advocate’ has been used by some health systems to describe friends or family members who accompany a patient, but for sensitive exams, patient advocates need to be trained professionals who understand what to expect, how to advocate for the patient and when to assist the provider.

Patient advocates step in when patients are at their most vulnerable — whether they’re undressed, sedated or receiving intimate care. Their role is to observe the interaction between the patient and the healthcare provider, and to intervene if anything deviates from standard procedures, could be misunderstood, seems wrong or violates trust. They act as a safeguard for both the patient and the provider, helping protect everyone’s rights and boundaries.

The Importance of Patient Advocates in Healthcare

Having a patient advocate in the room isn’t just a “nice-to-have” feature — it’s essential for creating a safe, transparent and respectful healthcare environment. In the past, patients often had to request an advocate if they felt uncomfortable, which places an unfair burden on them, especially when they’re expected to trust their healthcare professionals. Instead, healthcare providers should automatically include an advocate whenever a patient is vulnerable. Although the advocate’s interventions may be small, such as repositioning a drape for modesty, their impact on patient care, safety and experience is significant.

This should become standard practice in situations like:

  • Intimate exams
  • Sedation
  • Care for minors or patients with disabilities

Making It Standard Practice: Healthcare Training and Staffing

For patient advocates to become a standard part of care, healthcare organizations must prioritize all staff members — whether they’re front desk workers, medical techs or doctors — are trained to offer and arrange for an advocate when needed. This is a team effort, and everyone needs to be on the same page.

Cross-training programs and competency checklists can help make sure this policy is followed consistently across the organization. It’s not just about having advocates available; everyone must know when to offer one and how to do so in a way that puts patient safety first.

Onboarding and Ongoing Training

  • Effective onboarding and ongoing training are key to preventing abuse and ensuring patient safety. New hires need to understand what constitutes misconduct and how it impacts both the patient and the organization. From the start, a clear zero-tolerance policy for inappropriate behavior should be set.
  • Ongoing training keeps staff up to date on new laws, policies and emerging healthcare issues. Regular education helps everyone recognize sensitive situations and respond the right way. This approach maintains a high standard of care and always prioritizes the well-being of patients.

Credentialing: Ensuring Safe Staff

  • Credentialing is a crucial part of keeping patients safe. Background checks, license verification and reference checks are crucial first steps to ensure that healthcare staff are trustworthy and qualified to provide care.
  • Regular screenings help identify any potential issues before they escalate, making sure all staff members are continuously clear of any allegations against their license and committed to maintaining a safe environment for patients.

Do you have a patient-advocate-friendly environment?

Integrating patient advocates into the care process is a vital step toward creating a safer, more ethical healthcare environment. By making advocates a standard part of care, healthcare organizations can ensure that patients feel protected and respected, while also empowering staff to maintain high standards of safety and trust. This approach strengthens the entire healthcare system, fostering transparency and professionalism at every level.

Trend 2 — Educating Patients About What to Expect During Medical Exams to Prevent Sexual Abuse

One of the best ways to reduce anxiety and avoid misunderstandings during medical exams is by clearly explaining what patients can expect. This is especially important for sensitive procedures that might make patients feel vulnerable or anxious. Reporting inappropriate behavior is difficult if a patient is not provided with clear expectations prior to the exam or procedure. When patients are well-informed, they feel in control and confident about their care.

How To Educate Patients

Healthcare providers have several ways to ensure patients know what to expect before, during and after their exam or procedure. This includes:

  • Pre-appointment handouts: Giving patients clear, easy-to-read materials when they schedule or check in for their appointment helps set expectations. These handouts should explain the steps of the exam and let the patient know when a patient advocate will be present.
  • Patient portals: Leveraging mobile accessible tools allows patients to digest information when they are best positioned to learn. These tools often offer the provider the ability to track patient engagement and the opportunity to offer targeted reinforcement or comprehensive education as needed.
  • Posters in exam rooms: Placing simple, visible signs in exam rooms serves as a helpful reminder for patients. These posters can outline the procedure and explain the advocate’s role, which can ease anxiety by giving patients a visual reference.
  • Patient navigators: In specialized areas like gynecology or urology, patient navigators (trained professionals) can walk patients through sensitive procedures, answer questions and offer emotional support both before and during the exam.

Example of exam explanation:

Pelvic Exam

  • Undressing: You’ll be asked to undress from the waist down and cover yourself with a sheet for privacy.
  • Positioning: You’ll lie on your back with your legs in stirrups, which allows the provider to perform the exam.
  • Patient advocate: A patient advocate will be present to make sure you feel comfortable and respected throughout the procedure.
  • During the exam: The provider will start with an external visual exam, then use a speculum for an internal check (such as a Pap smear or HPV test). They may also perform a bimanual exam to check your uterus and ovaries. In some cases, a rectovaginal exam might be included.

Encourage Patient Questions

Patients should always feel comfortable asking questions or raising concerns before their exam. This open dialogue helps prevent confusion and ensures patients feel heard and respected. Healthcare providers can encourage this by asking simple questions like:

  • “Do you have any questions about the exam or what we’re going to do today?”
  • “Is there anything you’re unsure about or anything you’d like me to explain more?”
  • “How are you feeling about the procedure? Anything on your mind before we start?”
  • “Patients sometimes ask about the equipment that will be used. Would you like to see what all will be used as part of the exam?”

Making Patient Education a Priority

Educating patients about what to expect during their exams can significantly reduce anxiety and improve their overall experience. Whether it’s through handouts, posters, patient navigators or encouraging open dialogue, clear communication is essential. The message to patients should be: Don’t hesitate to ask questions, voice your concerns or share how you’re feeling. Your healthcare team is there to support you and ensure your experience is as comfortable and straightforward as possible.

Trend 3 — Implement a Speak-Up Program

Building a culture of accountability is essential for preventing abuse. That’s why healthcare systems need to create an environment where everyone including, patients, staff and visitors feels comfortable speaking up if they notice anything questionable, confusing, inappropriate or concerning.

Learn from Other Speak-Up Campaigns

Campaigns like the “Handwashing Posters” in hospitals or the familiar “See Something, Say Something” slogan at airports show just how powerful simple, clear messaging can be. A similar approach could make a big difference in healthcare settings.

An easy-to-remember slogan such as “Courage Speaks — Safety Listens” could be displayed on posters throughout hospitals or clinics. These reminders would reinforce the message to everyone — staff, patients and visitors — about the importance of speaking up and ensuring safety at all times.

Create a Culture of Safety

A speak-up culture isn’t just about encouraging people to report issues; it’s about creating a safe environment where everyone feels comfortable doing so. Staff should be trained to recognize inappropriate behavior and understand how to report it without fear of retaliation. Having open conversations about what counts as inappropriate behavior and how to speak up should be a natural part of the workplace culture.

Here are five tips for creating a successful Speak-Up Campaign:

  • Keep the messaging clear and simple: Make sure the campaign uses easy-to-understand, memorable messages that everyone can relate to. Something like the “See Something, Say Something” slogan clearly communicates which behaviors are unacceptable.
  • Use visible reminders: Display campaign materials — posters, flyers and digital signs — throughout the facility, especially in high-traffic areas like break rooms, waiting areas and hallways. This helps reinforce the message throughout the day.
  • Offer anonymous reporting options: Give staff, patients and visitors a confidential and easy way to report concerns, whether it’s through a hotline, secure website or physical drop boxes. This ensures privacy and protection for those who might fear retaliation.
  • Get leadership involved: Leaders should actively support and promote the campaign, leading by example. When leadership openly emphasizes the importance of speaking up, it shows staff that the initiative has their full backing.
  • Provide ongoing training: Offer regular training sessions to teach everyone how to recognize inappropriate behavior and how to report it. Don’t make it a one-time thing — consistent reinforcement keeps the campaign top of mind and boosts its effectiveness.

5 Signs of Potential Sexual Abuse by a Healthcare Provider

Sexual abuse in healthcare settings is a serious issue, yet it often goes underreported. Patients, especially those in vulnerable situations, can be more susceptible to exploitation by healthcare providers. To protect those at risk, it’s crucial to recognize the signs of potential sexual abuse. Here are five key indicators everyone should watch for:

1. Inappropriate Physical Contact or Invasive Examinations

What to Watch For: Unnecessary or excessive physical contact, especially when it feels unwarranted or uncomfortable. For example, a provider touching private areas without consent or clear explanation. Routine exams should never make a patient feel violated. If something feels off, trust the patient’s discomfort.

2. Patient Shows Fear or Discomfort Around Certain Healthcare Providers

What to Watch For: If a patient seems anxious, scared or reluctant when a specific provider enters the room or is assigned to their care. This could be a sign of past inappropriate interactions, especially if there’s no obvious medical reason for their reaction.

3. Conflicting or Inconsistent Explanations for Medical Procedures

What to Watch For: A provider offering vague or inconsistent explanations about procedures, particularly those involving intimate areas of the body. If the explanation doesn’t match standard practices or makes the patient uneasy, it might be a red flag for inappropriate behavior.

4. Unexplained Injuries or Trauma to Private Areas

What to Watch For: Unexplained injuries, bruising or trauma in the genital or breast areas that don’t have a clear medical cause. These may be dismissed as part of routine care but should be taken seriously and documented carefully, as they could indicate sexual abuse or mistreatment.

5. Sudden Behavioral Changes or Withdrawal After Provider Interactions

What to Watch For: If a patient suddenly becomes withdrawn, depressed or fearful after interacting with a specific provider, especially following an intimate procedure or exam. A shift in behavior could suggest that something inappropriate happened during the care they received.

Recognizing these signs is essential for everyone involved in patient care. If anyone suspects sexual abuse, speaking up promptly is crucial to protecting vulnerable patients and ensuring the right action is taken.

Trend 4 — Provide Bystander Training

Bystander training is an essential tool for creating a safe healthcare environment where everyone feels comfortable and supported in speaking up when something doesn’t seem right. It’s not just about recognizing inappropriate behavior — it’s about knowing how to act on it. Below are some real-life scenarios and tips on how to express curiosity, advocate in the moment, intervene, elicit patient feedback and report concerns appropriately.

How To Express Curiosity When Something Feels Off

Sometimes, the first step in preventing misconduct is simply noticing when something is unusual. For example, if a staff member sees a provider hugging a patient, it’s okay to express concern, especially if it’s not typical practice in the healthcare setting.

  • Bystander: “I noticed you hugging a patient. That’s not something we see every day. Are you okay? What’s going on?”
  • Provider: “She asked for a hug because she just learned she has cancer. I told her I don’t usually hug patients, but I made an exception in this case because she had no family with her.”
  • Bystander: “Makes sense. Just be sure you document that so there’s no misunderstanding. I’d hate to see that come back and bite you if the patient has a change of heart or if someone else saw what I saw. You never know these days.”

This kind of gentle questioning is essential for protecting both patients and providers. It shows concern without immediately assuming something inappropriate happened. The goal is to ensure transparency, good communication and proper documentation to avoid future misunderstandings.

How To Advocate in the Moment

Sometimes, it’s not about questioning behavior, but about advocating for the right course of action in the moment. Here’s an example:

  • Bystander: “Dr. Jones, don’t forget this,” handing him exam gloves.

This small action ensures that proper protocols are followed, helping the provider stay on track with patient safety standards.

How To Intervene

Intervening is sometimes necessary to prevent a potential issue from escalating. Here’s a scenario where a dental hygienist might be about to violate safety protocols:

  • Bystander: “Harry, the patient is sedated, and you can’t be alone with her or let anything block the line of sight until Dentist Falk arrives. There must be at least two people with the patient at all times. I’ll stay with you and the patient.”

This intervention ensures patient safety by reinforcing guidelines, while also providing support to the healthcare provider, helping them stay within professional boundaries.

How To Elicit Patient Feedback

It’s crucial to make sure patients feel comfortable expressing concerns. If a bystander notices that a patient seems uneasy, they should gently inquire:

  • Bystander: “Patient Sue, I’m concerned about your well-being. You seem startled or uneasy. Is there anything or anyone that’s made you uncomfortable?”

This open-ended question invites the patient to share their feelings without fear of judgment or retaliation. It creates an opportunity for the patient to voice concerns, which could be a critical part of identifying potential issues early on.

How To Report Incidents

If a bystander sees something that raises red flags, reporting the concern is the final, crucial step. Whether it’s through a formal system or speaking with a manager directly, the bystander should follow the reporting protocols in place. This is essential to ensure the issue is properly addressed and investigated.

The goal of bystander training is to empower everyone in the healthcare environment — from medical staff to support personnel — to act in ways that prioritize safety, transparency and respect. By encouraging a culture where speaking up is the norm, not the exception, healthcare facilities can prevent harm and maintain trust within the system.

Trend 5 — Consider Collateral Sources of Information

In healthcare, protecting patients and ensuring a safe environment requires more than just criminal background checks. While these checks are important, they don’t paint the full picture. To truly safeguard your patients, you need to gather information from multiple sources and be on the lookout for subtle signs of potential issues. Here’s how to take a more well-rounded approach to identifying risks.

Know the Red Flags of Sexual Abuse and Molestation

When hiring or evaluating healthcare professionals, it’s essential to watch for behaviors that, while seemingly harmless, may signal deeper problems. These “red flags” can point to potential ethical violations or misconduct. Here are a few to keep in mind:

  • Grooming behaviors: Does the staff member frequently volunteer for late-night shifts alone? Do they go out of their way to help others or give favors that seem excessive? While these actions may seem generous, they can also be a way to build trust and create opportunities for inappropriate behavior.
  • Boundary-pushing comments or actions: Pay attention to how individuals interact with others. Do they make jokes that cross the line, or brush off inappropriate comments as “just jokes?” Normalizing such behavior can desensitize others to increasingly inappropriate actions, making it harder to identify when things go too far.

While these behaviors may not immediately indicate something serious, they’re worth investigating. The sooner you spot them, the easier it is to prevent bigger problems down the road.

Standardize Feedback Collection

Another key to identifying potential issues is to regularly collect feedback from both employees and patients, right after an interaction. Don’t wait weeks or months to gather this information. Timely feedback helps organizations catch problems early and ensures that people feel comfortable speaking up.

Ask open-ended questions such as:

  • “Was there anything or anyone that made you feel uncomfortable today?”
  • “What was the best part and the worst part of your experience?”

These simple questions can provide insight into what patients or employees are experiencing and help shine a light on any red flags before they turn into bigger issues. Make feedback collection a regular part of the process — whether it’s through brief surveys or routine check-ins with staff. The more consistently an organization collects feedback, the more likely it is to catch issues before they escalate.

Don’t Silo Abuse Reporting

Abuse reporting shouldn’t be left to one department or group. Encouraging open communication across teams is critical for identifying and addressing issues early. Often, it’s not the victim who reports misconduct — it’s a colleague, a patient or even an outside observer who spots troubling behavior.

For example:

  • In one case, a security guard noticed a man photographing up women’s skirts. What seemed like an isolated incident led to the discovery of a much larger abuse case involving the woman being drugged and assaulted by her husband and others.
  • In another case, an investigation into child pornography uncovered evidence of abuse by a dental assistant. Though the initial investigation had nothing to do with abuse, further reports of suspicious behavior ultimately connected the dots.

These examples highlight the importance of paying attention to all sources of information, no matter how minor they may seem. Encouraging open reporting across departments helps connect the dots and reveals patterns that might otherwise go unnoticed. If a nursing assistant notifies Human Resources that a nursing supervisor has created a hostile environment by using sexually explicit language to describe her colleagues, Human Resources should alert the Patient Safety Officer and/or the Risk Manager who can investigate if or how the supervisor’s behavior has or could impact patient care.

Use Trusted Outside Eyes for Risk Assessment

It’s also a good idea to bring in outside experts who can evaluate the organization’s risk from an unbiased perspective. Independent risk assessments can identify blind spots that those within the organization may overlook. For example, OmniSure has been helping professional liability insurers spot risks, make recommendations and reduce harm for over 25 years.

By having a trusted third party assess practices, you can gain fresh insights into potential vulnerabilities in  the organization. These experts can point out areas where system changes, procedures or standards of care can be improved to prevent abuse or misconduct, providing the opportunity to address issues before they become a problem.

Creating a Culture of Awareness

Ultimately, patient safety and staff protection depend on taking a holistic approach. Relying on criminal background checks or any single source of information isn’t enough. By considering collateral sources — such as employee and patient feedback, cross-departmental communication and outside assessments — healthcare organizations can build a strong system for identifying and preventing abuse.

This proactive approach ensures that no issue slips through the cracks and helps the organization respond quickly if something does go wrong. It’s all about staying vigilant, connecting the dots and creating a culture where everyone feels responsible for the safety and well-being of those they serve.

Preventing Sexual Abuse and Molestation Starts Right Here, Right Now

A successful strategy to prevent and address sexual abuse in healthcare requires a collaborative, multidisciplinary team. Key roles that may already exist in the healthcare office or facility include:

  • Risk Manager: Oversees the reporting, documentation and investigation of abuse allegations. Works with legal teams and leadership to ensure a transparent process and protects whistleblowers and victims from retaliation.
  • Patient Safety Officer: Ensures patient safety by educating patients on their rights and abuse reporting procedures. Coordinates follow-up care, including emotional and physical support for victims, and provides access to counseling.
  • Quality Improvement Specialist: Ensures ongoing evaluation and improvement of abuse prevention policies. Regularly updates protocols, addresses weaknesses and keeps the organization proactive in maintaining patient safety.
  • Compliance Officer: Ensures adherence to legal and ethical standards. Oversees documentation practices and helps navigate legal challenges, minimizing organizational liability.
  • Education Specialist: Develops and implements training programs on recognizing, reporting and responding to abuse. Ensures that all staff receive trauma-informed care training and stay updated on best practices.
  • Clinical Representation: Frontline clinicians (nurses, doctors, therapists) who identify signs of abuse and take immediate action to protect patients. Their insights help refine operational practices to safeguard patient well-being.

Why OmniSure is the Right Choice for Your Risk Management Needs

When it comes to managing risks in healthcare, you need a partner who understands the unique challenges of the industry. That’s where OmniSure comes in. With highly specialized and seasoned consultants, 24/7 helpline for pre-claim advice-on-demand, powerful tools and customizable features, OmniSure offers comprehensive solutions to help you manage risks effectively. Here are five reasons why Omnisure is the perfect choice for your risk management needs.

1. Tailored Solutions for Healthcare

OmniSure isn’t a one-size-fits-all platform. It’s built specifically for healthcare, human services and senior care, meaning it’s designed to address the unique risks you face every day. OmniSure provides targeted solutions that meet the specific needs of healthcare organizations like those you work with.

2. Pre-Claim, Data-Driven Insights

Understanding risk trends and making informed decisions is easier with OmniSure. The program design provides clear, actionable data that helps you spot potential risks before they become serious issues. With real-time alerts and analytics, you can track patterns and adjust your strategies accordingly.

3. Insightful Updates

Staying on top of ever-changing regulations can be a challenge. OmniSure makes it easier by tracking and alerting you to the regulatory changes that matter most. From wide sweeping policy updates, to treatment-specific exposures , OmniSure ensures you’re always prepared with or just a phone call away from the answers you need.

4. Scalable to Fit Your Needs

Whether it’s small clinics or large healthcare systems, OmniSure scales with you. Start with basic features like the Helpline and a library of resources and add more support as your needs grow. This flexibility means you only pay for what you need, and you can expand your risk management capabilities as your business evolves.

5. Streamlined Training & Ongoing Engagement

OmniSure’s training modules keep your staff engaged and informed. Regular updates, interactive learning and customizable training programs with access to experts on demand ensure that your team is always equipped to address any risk.

With OmniSure, you get a risk management partner with solutions built to fit your needs, is easy to engage and grows with you. OmniSure helps you stay on top of risks, stay informed, reduce risk and control losses — so you can focus on what you do best.

Ready to talk? Reach out for a consultation today.

Five Strategies to Prepare Your Healthcare Organization for Digital Downtime

Healthcare runs on digital systems. Hospitals rely on electronic health records (EHRs), connected medical devices, and online communication to provide safe, efficient care. But what happens when these systems go down?

Cyberattacks, hardware failures, and natural disasters disrupt healthcare operations. In 2024, ransomware attacks on Change Healthcare and Ascension Health exposed the industry’s vulnerabilities. The Change Healthcare attack alone affected 190 million people, making it the largest healthcare data breach at the time. The Ascension Health attack forced hospitals to shut down IT systems, impacting 5.6 million patients and employees.

Digital downtime isn’t just an IT problem. When systems fail, patient safety is at risk. Delayed test results, communication breakdowns, and inaccessible medical records can lead to serious consequences. Regulatory bodies, including HIPAA, the Joint Commission, and the Centers for Medicare and Medicaid Services (CMS), mandate contingency plans to safeguard patient care during outages.

Hospitals must prepare for digital downtimes before they happen. To that end, this article – part of OmniSure’s series on 25 Trends in Risk Management for 2025 – analyzes several ways to fortify against the possibility of a digital disruption. This information will be helpful to insurance brokers, hospital administrators, healthcare providers, and others concerned with securing their organization from a potential system failure.

The 5 Key Strategies Included in This Guide

1. Create a Multi-Modal, Multidisciplinary Team to Prepare for a Digital Outage

A successful downtime preparedness plan requires collaboration across multiple departments. IT alone cannot manage digital failures. Clinical staff, administrators, and support services must work together to develop and implement response strategies. This ensures that hospital operations continue, and patient care remains uninterrupted when systems go down. Regulatory agencies such as the Joint Commission and HIPAA require healthcare organizations to establish contingency plans that include a multidisciplinary approach.

Key Stakeholders: Who Should Be Involved?

A strong response team includes representatives from the following departments. Each group has a critical role in developing and executing downtime protocols.

  • IT – Ensures system restoration and cybersecurity.
  • Clinical Staff – Doctors, nurses, and allied health professionals adapt workflows for patient care without electronic records.
  • Executive Leadership and Administration – Guides policy enforcement and regulatory compliance.
  • Support Services – Departments such as pharmacy, radiology, and laboratory services that rely on digital systems for operations.

Role Alignment – From Leadership to Frontline Caregivers

Every team member must understand their responsibilities. Hospital leadership should oversee strategy, while frontline workers need clear step-by-step guidance. Effective stratification ensures:

  • Executives allocate resources and prioritize preparedness.
  • Safety and Risk Management establish policies and procedures.
  • IT professionals develop alternative digital solutions.
  • Clinical staff implement manual processes seamlessly.
  • Support services coordinate backup workflows to maintain patient care.

Defining Responsibilities and Communication Protocols

Clear communication is key to downtime management. The team should establish:

  • Escalation Paths – Who reports what, and to whom?
  • Alternative System Communication Methods – Walkie-talkies, landlines, command centers, or in-person briefings.
  • Manual Process Guidelines – Paper charting, medication administration, patient communication, and lab result handling.

Cyberattacks such as the 2024 Change Healthcare and Ascension Health breaches have demonstrated the importance of clear communication during downtimes. Hospitals with predefined roles and protocols minimize confusion and patient risk during disruptions.

Case Study: A Successful Multidisciplinary Team Implementation

In 2024, a ransomware attack at Ardent Health Services, operating over 30 hospitals across six U.S. states, resulted in its electronic health records (EHR) being compromised. A multidisciplinary team, led by its chief digital & information officer and chief technology officer, carried out a structured response comprising containment, restoration, and recovery phases during the EHR downtime.

They quickly isolated affected systems, worked with operational leaders to restore critical functions, and repurposed clinical advisory committees to enhance communication. This comprehensive approach enabled the restoration of clinician access to EHR within 12 days.

Strengthening Team Preparedness for Digital Outage

Creating a multi-modal, multidisciplinary team ensures hospitals can handle digital downtimes efficiently. A well-structured team enhances response coordination, safeguards patient care, and ensures compliance with regulatory standards. Hospitals that invest in cross-functional collaboration will be better prepared for future disruptions.

2. Conduct a Business Impact Analysis (BIA) to Help Avoid a Digital Disruption

A business impact analysis (BIA) helps hospitals pinpoint their most critical digital systems and clinical workflows. It shows how interdependent these systems are and guides hospitals to focus on areas that matter most during a downtime. The BIA informs decision-makers about the potential impact of system failures on patient care and hospital operations. Regulatory agencies such as the Department of Homeland Security (DHS) and HHS ASPR TRACIE (the Technical Resources, Assistance Center, and Information Exchange) stress the importance of BIAs as part of business continuity planning. The Joint Commission also supports these practices to ensure that hospitals remain prepared.

Steps in Performing a BIA

Hospitals follow a structured process when performing a BIA. Using these workflows ensures hospitals know which areas need the most protection during a downtime. This process unfolds in three critical steps:

1. Identifying Essential Digital and Clinical Workflows

Hospitals must create a detailed inventory of systems and workflows that support patient care. Key items include:

  • Electronic Health Records (EHRs) – The digital backbone for patient information.
  • Imaging and Laboratory Systems – Tools that provide diagnostic data.
  • Pharmacy Management Software – Automated dispensing cabinets and systems that track medication usage.
  • Communication Networks – Channels like paging systems, VoIP, and secure messaging.
  • Clinical Workflow Integration – Supports such as pneumatic tube systems and inventory management systems. 
  • Security Systems – RFID technology, infant security, and automated door security (badge scanners and digital access panels). 
  • Regulatory and Compliance Safeguards – Product recall tracking systems and temperature/humidity remote monitoring systems. 
  • Infrastructure Integration – Building management systems and plant operations.

2. Assessing Potential Losses and Downtime Risks

Hospitals calculate the risks associated with system failures. They measure potential revenue loss, delays in treatment, and other clinical impacts. Every minute of downtime can affect patient care, delay lab results, and disrupt communication. The Joint Commission mandates that hospitals evaluate these risks to maintain operational continuity. By assessing potential losses, hospitals gain a clear picture of the stakes involved.

3. Prioritizing Investments in Mitigation Strategies

After identifying risks, hospitals must decide where to invest. Three areas they can channel funds toward include:

  • Backup Systems – To ensure data and operations continue during outages.
  • Cybersecurity Enhancements – To protect against future attacks.
  • Alternative Workflows – To maintain patient care when digital tools fail.

Past cyberattacks, like those on Change Healthcare and Ascension Health, reveal the high cost of inadequate planning. These events show that proactive investments in digital resilience save time, money, and lives.

Regulatory Guidance on Conducting BIA

Regulatory bodies offer clear frameworks for performing a BIA. DHS, ASPR TRACIE, and the Joint Commission recommend that hospitals update their BIAs regularly. They advise including every department in the analysis and using the findings to shape broader downtime response plans. These guidelines help hospitals align their practices with federal standards and prepare for emerging threats.

Lessons From Past Cyberattacks and Hospital Downtimes

Real-world incidents provide valuable lessons. The Change Healthcare ransomware attack disrupted billing and claims processing across the nation, while the Ascension Health breach forced hospitals to switch to manual workflows. Events such as these attacks show how well-executed BIAs can not only minimize financial losses but also safeguard patient care.

3. Assess the Effects of a Digital Outage on Patient Care

Digital systems drive daily hospital operations. When these systems fail, hospitals experience a direct impact on patient care. Clinical workflows break down, and staff struggle to access essential information. Doctors, nurses, and allied health professionals lose the digital tools they rely on every day. This disruption threatens patient safety and care quality. Regulatory bodies warn that downtime can lead to severe clinical consequences.

Potential Risks and Examples

Hospitals face immediate and long-term patient care challenges when systems go offline. Consider the following risks:

  • Delayed Procedures and Lab Results: Without timely access to digital records, diagnostic tests and procedures are delayed. Critical lab values are missed. This lag postpones treatment and can worsen patient outcomes.
  • Increased Mortality Due to Disrupted Monitoring: Continuous monitoring of vital signs and patient conditions can fail during downtimes. This lapse increases the risk of undetected critical events.
  • Medication Errors From Lack of Digital Verification: Electronic systems help verify medication orders and dosages. Without these tools, staff rely on manual checks, which can lead to errors.

Strategies for Mitigating Patient Care Disruptions

Hospitals can take steps to reduce the impact on patient care during digital downtimes. They must plan and develop alternative workflows. In turn, these strategies promote quick recovery and help maintain a high standard of care even when digital systems fail. Some strategies include:

  • Establishing Backup Communication Channels: Hospitals set up alternative methods such as landlines, two-way radios, command centers and in-person briefings to keep staff connected. These channels ensure that critical messages reach the right people during an outage.
  • Implementing Manual Processes: Teams prepare for paper-based documentation, medication administration, and lab result recording. Training staff on these manual procedures builds confidence and readiness.
  • Setting Clear Escalation Procedures: Hospitals define who should report issues and how to act when problems arise. This clarity minimizes delays and errors during downtime.
  • Conducting Regular Training and Drills: Frequent practice helps staff understand their roles during an outage. Drills simulate real-life scenarios to reveal gaps in the response plan and improve readiness.

Real-World Scenario Illustrating Downstream Effects

Real incidents show the dangers of unplanned downtimes. In July 2024, a global IT outage caused by a faulty CrowdStrike update disrupted operations in at least 12 major U.S. hospitals, including Cleveland Clinic and Mass General Brigham. The outage led to delays in lab test results, canceled elective procedures, and reliance on manual processes.

This incident highlights the critical need for robust downtime protocols and staff training to maintain patient care during digital disruptions. Hospitals that train staff and implement manual processes recover faster and reduce the risk of errors during disruptions.

Understand and Identify Risks

Assessing the effects of digital downtimes on patient care remains crucial. Hospitals must understand how system failures impact clinical workflows and patient safety. By identifying risks, planning mitigation strategies, and learning from past incidents, healthcare providers can secure better outcomes for patients during outages. This proactive approach ensures that even in the absence of digital systems, quality care continues to flow.

4. Implement Regular Drills and Simulations to Prep for Hospital Downtime

Routine drills help hospitals ensure every team member understands their role during digital downtimes. Drills expose gaps in current protocols and sharpen response times. Regular testing builds confidence in manual processes and backup procedures. A downtime roadmap published by Nurse Leader, titled “Prepare for Downtime Now,” stresses the need for frequent drills to verify that contingency plans work effectively.

Designing Effective Multi-Modal Downtime Drills

Hospitals design drills that mimic various real-life downtime scenarios. They conduct both scheduled and surprise exercises to test readiness. Effective drills combine multiple approaches:

  • Full-Scale Simulations: Engage all departments in a real-life scenario.
  • Tabletop Exercises: Bring staff together to discuss and refine response plans.
  • Role-Specific Drills: Focus on individual responsibilities to improve clarity.

These multi-modal drills ensure every facet of downtime response gets tested and improved.

Key Components to Test

Hospitals must focus on several critical elements during drills:

  • Alternative Communication Channels: Test systems like landlines, walkie-talkies, and secure messaging apps.
  • Manual Processes for Clinical Documentation: Ensure teams can quickly switch to paper-based recording.
  • Access to Backup Records and Emergency Protocols: Confirm that backup systems and emergency plans are fully accessible.

Testing these components helps hospitals maintain operations and safeguard patient care when digital systems fail.

Case Study of Successful Downtime Drills

In 2023, Cedars-Sinai Medical Center in Los Angeles implemented regular downtime drills to prepare for potential cyberattacks. These drills included the use of downtime boxes containing paper charts for each patient, necessary forms, and clear instructions for using business continuity computers. This proactive approach ensured that, during actual digital downtimes, clinicians could seamlessly transition to manual workflows, maintaining patient safety and operational efficiency. 

This example shows that regular drills can reduce risks and ensure a smooth transition when digital systems go down.

Lessons From Becker’s “Return-to-Paper” Playbook

Becker’s “Return-to-Paper” playbook offers proven guidance on managing downtimes. It provides step-by-step instructions for shifting from digital to manual systems. Key takeaways include:

  • Clear protocols for manual documentation.
  • Regular training and drills to reinforce procedures.
  • Ongoing evaluation and updates to downtime plans.

Hospitals that adopt these lessons experience fewer disruptions and maintain a high level of patient care during emergencies. For example, in 2024, a Texas hospital reverted to paper records after its EHR contract lapsed, highlighting the importance of having a manual documentation plan. Similarly, a California hospital faced an IT outage and successfully continued operations by switching to paper records, underscoring the need for preparedness. 

These real-world instances demonstrate the critical value of the playbook’s strategies.

Staying Proactive Can Lead to Greater Preparedness

Regular drills and simulations play a vital role in downtime preparedness. They help hospitals identify weaknesses and improve overall response. By designing multi-modal drills, testing key components, and learning from real-world examples, hospitals can better protect patient safety during digital outages. A proactive approach to drills builds team confidence and ensures care continues, even when technology fails.

5. Utilize Plan-Do-Study-Act (PDSA) Cycles Before a Digital Downtime Occurs

Plan-Do-Study-Act (PDSA) cycles drive continuous improvement in downtime preparedness. Hospitals use this approach to test changes and make data-driven decisions. PDSA cycles help teams learn from real-world experiences and drill outcomes.

Regulatory bodies, including the Joint Commission and DHS, encourage this method to maintain high standards of patient safety and operational readiness. With each cycle, hospitals refine their plans and adjust to emerging threats and evolving technology.

Steps in the PDSA Cycle

The PDSA cycle consists of four key steps. Each step builds on the previous one to create a loop of ongoing improvement:

  • Plan: In this stage, hospitals identify weaknesses in current downtime plans. Leaders set clear objectives and design experiments to test new approaches. The planning phase requires input from all key departments to ensure that every angle is covered. Hospitals develop a detailed action plan with defined responsibilities. This stage lays the foundation for successful implementation.
  • Do: Next, hospitals execute the planned changes on a small scale. They run drills and simulations to test the new strategies. Staff actively engage in these exercises to provide feedback on the processes. The goal is to see if the proposed changes work in a real-time setting. By starting small, hospitals reduce risks and learn valuable lessons without major disruptions.
  • Study: After the drill, hospitals analyze the results. They review what worked well and what needs improvement. Teams gather data on response times, communication effectiveness, and workflow efficiency. This phase offers a clear picture of how changes impact patient care and operational continuity. Hospitals document lessons learned and compare them against regulatory benchmarks.
  • Act: In the final step, hospitals implement successful changes on a larger scale. They update protocols, train staff further, and refine contingency plans. Hospitals integrate feedback to improve future cycles. This proactive step ensures that improvements become part of standard practice. By acting on study findings, hospitals build a culture of resilience and adaptability.

Adapting to Emerging Threats and Technological Changes

PDSA cycles enable hospitals to adapt quickly. Each cycle offers a chance to update strategies based on the latest challenges. Hospitals can adjust to changes in cybersecurity, software updates, or shifts in regulatory requirements. This flexibility ensures that downtime plans remain effective and up to date.

Integration With Regulatory Compliance Requirements

Regulatory bodies typically require continuous improvement in healthcare operations. Hospitals that use PDSA cycles meet these requirements and show a commitment to quality care. The structured approach helps hospitals align their practices with guidelines from the DHS, Joint Commission, and other regulatory agencies.

Using Best Practices to Lead the Way

PDSA cycles provide a systematic way to improve downtime preparedness. Hospitals actively plan, test, study and act on improvements. This method drives a culture of continuous learning and rapid adaptation. By using PDSA cycles, healthcare organizations build resilience, safeguard patient care, and meet regulatory standards. The cycle empowers teams to address emerging challenges and refine processes for a secure, reliable future.

The Five Strategies to Keep in Mind to Avoid a Digital Outage

Preparing your healthcare organization for digital downtimes is a continuous, proactive process. We have discussed five key strategies: creating a multidisciplinary team, conducting a Business Impact Analysis (BIA), assessing the effects of downtime on patient care, implementing regular drills and simulations, and utilizing Plan-Do-Study-Act (PDSA) cycles for continuous improvement. Each strategy plays a vital role in building resilience and ensuring patient care remains uninterrupted during digital outages.

Remember these four key takeaways:

  • Proactive Planning Saves Lives: Hospitals must plan for system failures before they occur. Robust contingency plans help protect patient safety and maintain operations even during severe disruptions.
  • Teamwork Is Essential: A multi-modal, multidisciplinary team that includes IT, clinical staff, administration, and support services strengthens your response to digital downtimes. Clear roles and communication protocols ensure quick, effective action.
  • Analyze, Train, and Adapt: Conduct comprehensive BIAs to understand your digital dependencies and review them frequently as your enterprise digitally evolves. Regular drills and simulations, paired with continuous improvement cycles like PDSA, help you spot weaknesses and refine your protocols to address new challenges.
  • Invest in Resilience: Allocate resources for backup systems, cybersecurity enhancements, and manual workflow processes. These investments reduce downtime risks, minimize losses, and ensure that patient care continues seamlessly even when technology fails.

By embracing these practices, hospitals can better navigate the challenges of digital downtimes, safeguard patient care, and maintain regulatory compliance. Building resilience today means protecting lives tomorrow.

OmniSure Is the Right Choice for Your Risk Management

With OmniSure, you get a risk management partner with solutions built to fit your needs and grow with you. OmniSure helps you stay on top of risks, stay informed, reduce risk, and control losses—so you can focus on what you do best. Our tailored solutions can help you navigate today’s most difficult risks.

Ready to talk? Reach out for a consultation today.

Mark Batten – Celebrating 20 Years of Service

Today, we at OmniSure would like to take a moment to recognize and celebrate our COO, Mark Batten, as he reaches an incredible career milestone: 20 years of service. This occasion marks two decades of contributory leadership and a legacy that has helped OmniSure’s CEO shape our company into a trusted voice in patient safety and clinical risk management.

In these 20 years, the business landscape has evolved dramatically, and Mark has been at the OmniSure roundtable helping to strategize and problem solve with every shift. When he first started in the risk services coordinator role, he received our orders for risk assessments by fax and shipped out risk management manuals in binders. Mark’s loyalty, strong sense of responsibility, and ability to pivot with the times have helped OmniSure evolve with the world and thrive along the way. We have come so far and grown so much thanks to Mark’s loyalty and servant leadership.

Mark has not only helped OmniSure grow and evolve, but he has also helped create the culture that defines what OmniSure stands for. He has never been afraid to share hard truths, or keep us grounded, and at the same time, through his dedication to those he serves, has demonstrated his investment in the careers and lives of those he works with.

From Risk Services Coordinator to COO and part-owner, his journey here has been special, and we are grateful to have been a part of it. Thank you, Mark! We are excited for our future knowing you have such an influential role.

Celebrating Laura Luck Martinez: A Journey of Excellence in Healthcare Risk Management

We at OmniSure would like to take some time to celebrate someone truly special: Laura Luck Martinez. From her beginnings in risk management providing medical and vocational case management to her most current role as the Chief Risk Officer and Executive Vice President at OmniSure, Laura Luck Martinez’s career has been defined by excellence, dedication, and care.

Laura’s expertise over the years and the deep relationships she has formed come from serving as senior nurse consultant workers compensation for Zurich and Chubb & Son, a Risk Management Consultant for Chubb & Son, the Vice President and Healthcare Risk Manager for Darwin & Allied World, and Vice President for MagMutual before joining OmniSure six and a half years ago. Each role not only sharpened her skills but also solidified her reputation as a trusted leader in the field, especially with Healthcare Professional Liability Underwriters.

However, it isn’t just her professional trajectory that has set Laura apart; it has been her unwavering commitment to the wellbeing of our healthcare clients and to patient safety that truly has distinguished her. She had the perfect blend of credentials and she used them. Her Associate in Risk Management, her Certification as a Professional in Healthcare Risk Management, her Masters in Counseling, and her training as a Registered Nurse. She has an amazing ability to set others at ease when faced with what seems to them as an enormous challenge or urgent crisis.

Anecdotes abound of her relentless pursuit of knowledge and thoroughness in serving our clients. According to OmniSure CEO, Michelle Foster Earle, “when an Underwriter seeks guidance on the risks associated with some new treatment or therapy, it’s not uncommon for Laura to consult UpToDate for the latest guidelines, delve into the regulations, read and summarize expert insights, or even delve into a Netflix series or documentary to get as many perspectives as possible. Laura never simply met our client expectations, she’s always exceeded them.”

Laura’s willingness to go the extra mile, helping OmniSure to craft innovative solutions to complex challenges, earning the trust and admiration of many along the way has had a meaningful and lasting impact on all those she’s served, extending well beyond her professional duties.

Here’s some of the things our clients have said about Laura over the years…

Testimonials praising Laura Luck Martinez’s helpfulness, expertise, and supportive advice are arranged around the image.

Naturally, we couldn’t fit even a fraction of the amazing comments our clients have made about Laura, but we did our best to give an idea of what an amazing reputation she has earned.

We celebrate Laura’s extensive and amazing career and as she embarks on a new chapter, we want to express gratitude for her invaluable contributions. Laura, from all of us at OmniSure, we thank you for your exemplary leadership, for fostering enduring relationships, for mentoring so many of our consultants and teammates, and for simply being you. Your presence will be sorely missed, but as a true leader, you have set us up for success for many years to come. Your legacy will endure, a testament to the profound impact you’ve had on all of us. You will always have a family at OmniSure.

Welcome Madi Edwards to Our Team!

We are thrilled to introduce the newest member of the OmniSure family, Madison Edwards, RN, MSN, who joins us as Executive Vice President of Clinical Risk Services. Madi brings a wealth of experience and expertise in healthcare, making her an invaluable asset to our team and to our clients and partners.

Background and Experience

Madi comes to us with over a decade of experience in the healthcare industry, focusing on risk management and patient safety. Her career began at INTEGRIS Health as an operating room nurse, where she sped through the ranks, eventually becoming the Director of Outpatient Surgery before serving in the capacity of Director of Nursing of INTEGRIS Lakeside Women’s Hospital. She then served on the Oklahoma Board of Nursing as the Associate Director for Nursing Practice, where she regulated nursing practices pertaining to all registered nurses in the state. She eventually returned to INTEGRIS Health, this time as the Director of Clinical Programs and Surgical Services, where she helped develop and implement new care pathways, caregiver training and education, and focused on mitigating risk through standardized care.

Her deep understanding of the challenges and opportunities in healthcare will enable her to provide tailored, proactive advice to protect and benefit healthcare providers and their patients.

What Madi Brings to OmniSure

Madi’s appointment reflects our commitment to excellence and leadership in healthcare risk management and patient safety. Here are a few ways Madi will be contributing:

Strategic Risk Assessments: Utilizing her extensive knowledge to identify areas of potential risk, she will be an asset in helping your clients proactively address issues to ensure the highest standard of care and safety and, in turn, greatly reduce risks.

Ongoing Support and Guidance: Madi will be a direct resource for you and your policyholders via our helpline, providing expertise and support as you navigate the complex landscape of healthcare risk management.

What People Have Told Us

To give you an idea of the powerhouse joining us, here are some of the things we at OmniSure have been told about Madi by those who have worked with her:

“Madi is one of a kind. There’s not much she can’t do. She made my job a joy. There’s something magnetic about her. Everyone respects her; the physicians, the multi-hospital health system’s leadership. She inspires confidence, makes you feel secure. I could trust her with everything in my absence, including presentations to the board. She handled all the needed documentation for compliance and accreditation. She’s self-directed and innovative … the best.”

-Hospital President, Chief Nursing Officer

“Incredibly efficient, organized and meticulous. Super smart, understands the legal landscape, has been around attorneys her whole life. Also, if she doesn’t know the answer to something, she’ll say so and then go research it. She runs circles around most people. She’s so thoughtful and she’s just been on the ball with everything she’s done.”

-Attorney who worked closely with Madi

“The clients are going to love Madi. She’s a perfect fit for OmniSure.”

-Hospital and Miscellaneous Medical Facilities Underwriter

Connect with Madi

We encourage you to connect with Madi to discuss your current challenges and how she can assist you in achieving your goals. Madi is looking forward to working closely with each of our clients and making an immediate positive impact.

Please feel free to reach out to her via our helpline, or emailing us at [email protected].

Thank You,

We are excited to see the ways in which Madi will make a significant impact on our projects and partnerships. Thank you for being a part of our community, and we look forward to continuing to support your needs.

A Discussion on the Risks and Best Practices in Mental Health and Substance Use Disorders Care

The current environment has highlighted the increased demand for both mental health and substance use disorder care needs. Recently, Michelle Foster Earle, president and CEO of OmniSure Consulting Group, sat down with a well-respected industry leader in risk management in these clinical areas, Monica Cooke, BSN, MA, RNC, CPHQ, CPHRM, DFASHRM. Their insightful exchange on risk mitigation in these settings follows.

Michelle:
Monica, you’ve been in this field a long time. Tell me a little bit about your background. How did you get into risk management for mental and behavioral health?

Monica:
I’ve been in mental and behavioral health for a total of 44 years. I am a nurse; I started my career in the alcohol treatment setting. It was the initial nursing position for me, and then I moved into psychiatry a few years later. Clinically it’s been my entire background. I’ve worked in child and adolescent inpatient settings, adult residential, and state facilities where people are there for a long time. I’ve had a lot of clinical experience. And after 30 years, I went into leadership management. I became a director of nursing, director of risk, and director of quality, all in the last few years of my pre-consulting career, when I had a real job as my husband would call it. I kept seeing the same things repeatedly, everywhere I worked.

I saw it as a matter of working to reshape culture when it comes to risk management and quality care. I decided that I really needed to get the word out on a broader scale. So, I did; in 2006, I started my own business in risk management and quality. I am certified in both as well as a certified psychiatric mental health nurse. I have worked clinically up until COVID-19. I was working with substance use patients before their dropped census. For the past 15 years, I have been doing risk management as well as legal nurse expert work across the country in behavioral health and substance use.

I think my interest in it is that risk is always going to be there. For most organizations, it is a matter of doing a good assessment, looking at where they’re at now, what are the risks, thinking it through, and offering recommendations on how they could improve and minimize the risk while also helping them decide what risks they’re willing to tolerate. There are a lot of risks we must tolerate in mental health and substance use settings or care and treatment across the board. So, as we know in any healthcare arena, we can’t get rid of all the risk; we can’t mitigate it all. But we can look at what we have and decide on how to prioritize the risks.

The detective work, figuring out what’s going on in an organization, that’s what I enjoy doing. A lot of it has to do with the culture of the organization and the leaders. Where are they coming from, what is their philosophy of care, and what is their attitude toward workplace violence and taking care of staff? As we know, workplace violence is a big concern in healthcare across the board.

Michelle:
Well, I’m going to ask you a lot about risk management, patient safety, and taking care of staff in a few minutes, but you mentioned just now that you were working in a clinical capacity until COVID and that the census went down. I received a question yesterday from an underwriter about claims during the COVID period, and I explained this particular class of business census went down, and because of that, they’re going to see fewer claims because there were fewer patients. Is the reduction in the census something you think has happened across the board in behavioral and mental health or was it just in addiction treatment?

Monica:
No, I think it happened across the board. I think that part of the dilemma, and more so with mental health inpatient type settings and partial hospitalization settings, was the risk of exposure due to patients coming in and going out on a daily basis and potentially being admitted with COVID. Most organizations do test routinely prior to entry because we have issues with compliance; patients that are at times psychotic are often unable to cooperate with hygiene and care policies associated with COVID precautions.

I live in Maryland, and the Metro DC Baltimore area saw a lot of substance use settings close or the census lower. For instance, the facility I worked at had a 40-inpatient-bed detox and rehab unit, went down to 10 initially, then started bringing census up so that each patient could have their own room, with minimized contact, COVID testing, isolation, retesting, etc. consistent with COVID guidelines. That takes a lot of energy because it requires redesigning the entire treatment program.

Interestingly, it had a good impact in our facility by changing the program to more focused small group care and treatment, as opposed to large groups of 40 patients. But certainly, access to care, in 2020, was prohibitive. The emergency rooms were flooded with mental health patients because facilities lowered their censuses, and inpatient beds were not available. Certainly, care access went down because of COVID, but programs are beginning to, I think, come back and be more available.

Michelle:
I’m just intuitively assuming mental health and substance use treatment needs to be more available now because it’s been such a hard couple of years on so many people. I’m sure that there were many more relapses from people being triggered, depression, anxiety, from all that everybody has endured, from not seeing friends and family members. And for those working in health care, the trauma of seeing so many patients and colleagues get sick and die. It’s been a tough couple of years.

Monica:
And, interestingly Michelle, one of my bigger concerns was with care providers. Because of the stress on them and their families, the increased use of substances . . . alcohol, marijuana, pills, anti-anxiety meds, other things that may or may not be prescribed, yes, increased substance use in healthcare providers is a risk. I often speak to groups and share the need to educate everybody. Care providers need to be aware of their own risk, to watch their peers, and the people they work with: are they acting differently, do they smell alcohol on their breath, have they noticed any differences in their behaviors? These are very real scenarios that are happening because healthcare providers are trying to manage the increased care load; home, kids, and families; and the healthcare crisis. It is so very, very, very stressful. It is critical they receive support from a mental health perspective.

Michelle:
Let’s get to the initial topic of risk management. You’ve undoubtedly seen the best and the worst situations. What stands out as one of the worst situations?

Monica:
Probably the worst scenario was both a liability and a law enforcement issue. It involved an inpatient psychiatric unit for adults where a patient had hanged herself in the bathroom and was not found for about two hours. When the staff found her, they took her down and sat her on the floor to make it look like she had just died. Then they told their charge nurse that the patient was sitting on the floor and wasn’t breathing. Because she died, it also became a police matter.

Initially, the ligature marks were not visible; however, when the police arrived, the ligature marks on the neck were visible. Then of course, the real story came out after a review of video from the hallway cameras. No one was monitoring the patient every 15 minutes according to protocol. The staff, mostly techs, are assigned to monitor the patient. They attempted to cover up the lapses out of fear they would lose their jobs. As a result of the falsified reporting, the investigation turned into a possible homicide.

Of course, it turned into a liability issue for the family of the deceased. It is understood someone can die from strangulation in a few minutes and that established safety parameters are for rounds every 15 minutes. However, if they had been conducting the rounding, they may have prevented it or may have been able to resuscitate her. The corporate parent company asked me to meet with the staff and assess the culture. The question was, is this a culture issue, a culture of care issue?

I determined the culture was very bad, much like what I had previously seen in some inner-city hospitals. While the staff had the required competency, they were not very sophisticated. The leadership was facing a tremendous challenge to shift the culture, and that was going to require hard work and time. I think that’s probably the worst situation I have seen. Sadly, it wasn’t just that someone failed to do a required safety check. The attempt to cover up the failures was a significant cultural red flag.

Michelle:
In hospital settings, there’s been a lot of work to change and shift away from the blame culture, which is our human nature really. When something goes wrong, and especially when the most egregious things go wrong, we want someone to blame. Somebody needs to pay the price. People at the top, especially if a scapegoat helps ease the situation, can be quick to fire a wrongdoer. So then when unintentional mistakes happen, people get scared and think, what could possibly happen here? Someone could lose their job and be terminated. The person who made the mistake has a family to support and can’t afford to lose a job. So, if they can, they brush it under the rug. But that does nothing to help others keep from making the same mistake. It causes people to falsify records, hide, lie, or run, in fear and be scared. Blame culture doesn’t have anything to do with intention; it just has to do with the outcome.

In a just culture, you look for systems to fix. How did the system fail the clinician at the point of care? If the clinician was supposed to be checking on the patient every 15 minutes, was there some reason that the clinician wasn’t doing that? Was it a staffing issue? Was it an issue with the location of the patient room? Was there a clear handoff from the previous shift with specific action items? Who knows what the system fixes could have been had the staff not felt the need to cover it up? The shift from blame culture to fust culture hasn’t happened across the board at all hospitals. We’ve done a good job of it, but I’m interested in how many psychiatric and behavioral health settings have even heard of just culture. Is that something they are looking at and thinking about?

Monica:
Certainly, for the most part in my early career, thinking through systems was not yet a concept. But at this point, it is. When I do risk assessments, that’s what I look for: is it a just culture? What do staff understand about what follows when something negative happens? What happens to them? Digging into incident reporting and near-miss reporting practices are a big focus issue for risk managers.

I grew up in nursing in the ‘70s as an RN, where if you put in an incident report, it went in your personnel file. If you made an error on medication or anything, it went into your personnel file, and then annual reviews came up, and oh, you made three med errors, and you’re not getting your raise or your merit increase. I think we’ve done well. I think that for the most part, psychiatric settings are keeping on par with hospitals. The hospital where the patient hanged herself certainly knew about just culture. But changing the culture takes a year or two years; it doesn’t happen overnight. Everyone must buy-in. Everyone must believe in it. Everyone must practice it every day. It takes a lot, and they knew that was an issue. And in fact, that was a contributing factor to what occurred. And of course, there was intentional deceit, and intentional deceit is unacceptable in any just culture. Just culture lays the foundation for the questions, is there a system issue to explain why they couldn’t do the rounds every 15 minutes, do they not have enough staff, do they feel overloaded? All those things must be considered and investigated without bias when a sentinel event occurs.

Michelle:
Right. In a blame culture, people are more likely to do what this staff member or team did, which was to hide the error. And then it becomes intentional falsification of records, which takes on a whole new life of its own. Within the just culture, you reward and encourage people for speaking up. That staff member who found the patient might not have tried to cover it up in a just culture and would’ve said, “Oh my goodness, I haven’t been in that room in two hours. Look at what happened! I was busy helping Jane who had this problem over there, and I feel so horrible.” Everyone would have looked for ways to keep it from happening again. In a just culture, she was not necessarily going to be terminated; she would have been handled fairly. The whole organization would look to learn from the situation that led to this sentinel event, a patient’s death, and hopefully prevent it from happening ever again. There’s no tolerance for deceit; that would be grounds for termination.

Monica:
That’s right, they did have to terminate them.

Michelle:
Exactly. Once you’ve falsified records, you can’t go back. So then, what would you say might have prevented that error from happening or that outcome? Obviously, we know the 15-minute rounds might have helped. Do you think that leadership embracing a just culture would’ve been the number one thing to have in place beforehand to keep that from happening?

Monica:
I think just culture plays a big part in it. We need staff to know they can make a mistake and not lose everything they’ve worked for. Prior to just culture, if we made a medication error, not only could we be fired, but people were fired. I think that the change has been a huge influencer toward open and honest communication and improved patient outcomes. In the sentinel event we discussed, I think that the system failures included a lack of adequate supervision.

I am aware of mental health facilities that have increased supervision because of the liability associated with failure to meet the 15-minute check standards. If there’s a legal case, that’s the first thing I want to see: the Q 15-minute checks logs. There are many ways they can be problematic, ranging from being blank to being falsified, which makes having a double-check system in place vital. The mental health techs are usually accountable for completing these rounds, managing the milieu of the patients, and reporting concerns to the nurses. Because nurses are busy doing admissions, medications, and providing clinical care, supervision is often lacking.

I recommend a system where the nursing staff is directly involved in those Q 15-minute rounds on a regular basis. For example, once an hour, the rounds are completed by the nursing staff. This promotes their engagement and ownership of the team’s accountability and allows for increased vigilance and supervision while elevating the importance of the duties. That’s one approach, and because most facilities are very much aware that a failed system leads to high risk and high severity outcomes, Q 15-minute checks are a top priority to ensure patient safety, and teams are being trained and systems implemented to reduce these risks.

Michelle:
OK, let’s go to the opposite side of the risk spectrum. Share something about going into a setting where maybe you said, “Wow, this place has really done a great job with risk management and patient safety!” And what were they doing that impressed you?

Monica:
I don’t get wowed too much. Beautiful and newly designed facilities that meet current standards can mitigate about 80% of our risk. That is accomplished with design, just design. The higher quality organizations are most commonly newer facilities that are designed with safety as a priority, as opposed to an old med-surge unit that’s been converted into a psych unit. Some of the best facilities are the ones with more resources; however, resources alone are not the answer.

The thing that really impresses me, which really tells me that they have strong risk management, is if the staff can speak to it, is data monitoring, if they can speak to data, what they’re monitoring, what their high-risk concerns are. And not just leaders because leaders get it drilled into their heads but the staff. I’ll ask a nurse or a tech what are your biggest risks? What are you monitoring here? What are you trying to make sure doesn’t happen? They’ll say things like, “We really watch out for contraband. And we’ve implemented this strategy to take care of it at the door.”

The staff’s ability to speak to it is evidence of their involvement, and that is huge. Everyone’s a risk manager. I know we’ve all heard this before, but everybody really is a risk manager. For a risk management department, it is about getting the frontline people, the people that are doing the job every day, getting them on board with what are we trying to get better at what we are wanting to do about it. What does our data show, for example, about how many restraints incidents they have had and how incidents have lessened because of what they have implemented?

Michelle:
Yes, and not only are they getting real-time feedback on the things that everybody is concerned about and wants to see improved, but they can also be part of the solution. We all need feedback to improve. When I was an administrator, we would intentionally bring in the nursing assistants and the frontline workers to help solve problems because they were the only ones who really could solve the problems right there at the point of care. They saw and knew what was happening in ways that we did not, what equipment was available, why they needed assistance with a particular type of client, what works, and what doesn’t. So, you’re right. That’s an excellent point that if the frontline staff is part of the risk management performance improvement projects and the data from the quality assurance and performance improvement are shared with them, they know how they’re performing, they are being involved, and they are on the same page with the solution. That’s excellent.

Let’s talk about the newest design you mentioned and its importance. If you’ve got the facility itself designed to solve several risk problems, that’s absolutely beneficial. However, aren’t those going to be more expensive than the treatment facilities?

Monica:
It’s not necessarily expensive in terms of the cost of care. At our hospital, we take public assistance, and yet, it’s a newly designed hospital. It’s not that these are more elite facilities but rather that they are designed for improved safety, which gives them a huge advantage over the traditional psych facilities that are either inpatient units in a hospital or freestanding, but they were not built for that purpose. Because they were built for something else and repurposed, they have their own risk challenges. Even a recently built rehab building that has been repurposed will have increased risks because the design is not the best environment for this population and their safety needs. Do you see what I’m saying?

Michelle:
I totally do. We have a facility in our city where they took one of those nursing homes that had a layout like the spokes of a wheel. They had the central nursing unit and all the hallways where they had specific designations. One became the adult female hallway, one became the co occurring disorders hallway, and so on. You could tell it was an old nursing home that I guess didn’t make it as a nursing home, but they had converted it into a drug and alcohol treatment facility.

Monica:
Yes, that’s exactly what happened. With the Joint Commission and CMS guidelines, the trend is toward a mandatory safe design. Retrofitting that design is not as good as if it were built specifically to meet the current standards. Because units could still have a lot of blind spots and the bedrooms are far away from the nursing station, like with those spokes, not only does observation become a problem, but the need for maximized observation cannot be accomplished. The nursing station you referenced likely was not nice, low, and open or positioned centrally where everyone is interacting, with a big day room out in front of it where patients can socialize.

I think that now we have a lot more pressure from regulatory and accreditation bodies, things have gotten better regarding design. But people have put millions of dollars into rehab units, and we know that mental health dollars are lean. There’s no parity. Nobody’s making money in mental health. Well, I can’t say nobody—but most. I mean, they’re barely getting by.

Michelle:
Yes, I really like the idea of the question: Was it designed for the purpose it’s being used for? And that’s a more important question than “Is it a luxurious facility or one that serves the lower income?” because I know that is a question people are asking. You look at some of the drug and alcohol treatment facilities, and they look like a destination vacation on the beach with horseback riding, but those are all private pay. So that is a question that comes up: Are they less risky than a facility that has a minimal budget but treats a lot of people that are underserved and don’t have the resources for something like the “really nice” rehab?

Monica:
Well, for the most part, substance abuse facilities have different risks. The risks aren’t the same as they are with mental health. There is a much higher risk in a mental health setting than in a substance abuse setting. And yes, there are the luxurious, resort-type, go swimming every day and get massages and all those things, in substance abuse settings. And there are a few, though not many, very, very private elite mental health facilities too. So, what they offer is not necessarily a better design or even a safer design, but what they offer is more and multiple clinical treatments. For instance, Betty Ford is an old facility, but they offer things that you wouldn’t get at a typical substance abuse treatment facility, like massages, acupuncture, and yoga, all these kind of relaxation therapies that absolutely do help.

The problem is that they help during the stay, but does the person then go home and do those beneficial things to help them to maintain their sobriety? The other types of facilities that don’t offer all those perks, they most likely suggest these modalities to patients or something equally relevant. If they’re in a detox/rehab setting for, say, three weeks, they work to establish a recovery plan for somebody based on what they have access to. Now people with a lot of money have access to yoga and massages and all those things that can and do help, whereas somebody with funds that are severely limited or nonexistent . . . they’re not going to get a $100 massage to prevent a relapse. I think that’s the difference.

And of course, we know there’s a lack of parity in terms of health care: just being able to pay for what you want. I mean, we have concierge doctors, right? People can pay for a concierge doc to call at any time of the day, but you pay a fee for that. I believe that the biggest difference between them is not so much the design because there are some bad designs. Substance abuse freestanding settings are very well known, trust me. But they offer more. They have more of a variety of services, more staff, and they have greater access to all different types of resources in the community. So that’s what really makes them different. Now the question is, are they better because they help all that? From a risk perspective, the question is do some of these other available services come with their own risks?

Michelle:
We have one consultant who was an administrator at a drug-and-alcohol-treatment residential facility, which had equine therapy. And so, what kept her up at night was not somebody relapsing, but it was someone getting thrown off the horse or getting kicked by one of the horses.

Monica:
Well, Michelle, equine therapy or therapeutic riding is wonderful therapy. We have a gym here for our substance use patients, and we have more injuries in that gym. It’s a younger population often, and they’re substance users and haven’t done any exercise or played basketball in 10 years, and suddenly, they’re clean for a week and want to go down and do high jumps, and then they fall and sprain their ankle. I think those are always risks. And again, it’s what risk can we bear? What risk can we accept? If those risks do exist, then we must have a sense for them: which ones are we able to accept for what is best for patients?

We have a challenge course outside where they climb up ropes, they swing on ropes at high distances, they walk a tight rope with a harness, and they do all kinds of things. Is that risky? Yes, that’s risky. We have never, ever had a harmful event in 30 years of the challenge course at this substance abuse facility. And I credit that to the good therapists that are doing it. They’re consistent with being very stern about what all the safety rules are. It’s not a joke, and we don’t play around. They really keep things in check. We have people sign a release when they come in stating you’re going to get adventure therapy, it
involves this, you consent to that, we won’t be liable, etc. They can consent to physical activity.

Michelle:
Here’s another scenario: We all hear about substance abuse settings where patients discharge perhaps prematurely, due to limited benefits or resources, and then they relapse and die of an overdose a day or two later. What’s at play there, and what can we do to prevent that type of tragedy?

Monica:
I think substance use is a chronic illness, and it’s a very relapsing illness, and we all know that in the industry. We accept public funds as well as private funds or private insurance. And there certainly are patients where the insurance says, no, they’re only getting five days of detox, we’re not paying for rehab, etc. Those patients then become a high priority for establishing a good recovery plan at the point of discharge. We need to ensure we have established good assessments and, of course, that they are medically stable at the point that we discharge them. We work with them on a good recovery plan that has many components, such as AA, medication, individual therapy, or outpatient group therapy. And most of our patients successfully step down from inpatient to intensive outpatient, where they come in three times a week for a couple of hours. If they refuse it, that’s one thing. If they don’t refuse it but don’t stay with the plan, that kind of falls back on them. From a liability perspective and a risk management perspective, I’ve never been very concerned about that. Those tragedies do happen. People who are substance users are not incompetent; they are able to make their own decisions. If they decide to start using, there are consequences for that, and they are aware of those consequences; there are known consequences.

We do have patients that leave AMA (against medical advice), and there are a lot of substance users that go into treatment and a day later say, “I don’t like this; I want to use some more,” and they decide to leave. From a liability perspective, we don’t worry about the AMA cases as much.

Michelle:
It sounds like the best thing is to have some sort of system in place so that there is a good transition. You’ve done a good handoff to the step that’s right for them, either to continued treatment, to the primary care physician, or to an AA program with a sponsor, whatever that plan is, just making sure that you do a complete handoff. Like at the ER, the goal is to keep the person from having to be readmitted within 24 or 48 hours because that signifies that maybe the treatment wasn’t provided sufficiently, or they were prematurely discharged. I would say, then, that for treatment for drug and alcohol abuse, it’s probably the same thing. You want to make sure that there is a good handoff in the continuum of care. The ERs call the patients 24 to 48 hours later and say, “Now when we discharged you, we discharged you with a prescription for this particular antibiotic and instructions to get in touch with your primary care physician. Have you been able to schedule that appointment?” The ER is making sure that they’ve done a good handoff.

Monica:
It’s a good practice. It’s not universally done; some health systems are better at it than others. I think what’s important, again from a liability perspective, and what most ERs do in their discharge instructions, is they make it clear that “if you have any problems, come back to the ER.” What we say here is, “If you start having any issues, call us. Call us, and you may need to come back, or we can give you more resources, or we can facilitate you getting what you need.” So, they know that at the point that they leave, they can always call back.

Michelle:
That’s great. Thank you, Monica. It’s been an enlightening conversation.

We are the highly-specialized partner industry leaders depend on for exceptional risk management solutions, loss control service, and support. For further information on how to mitigate risk, get in touch with OmniSure today.

The Dawn of Digital Healthcare: Risks and Strategies for Liability and Coverage PLUS Webinar

The intersection of cybersecurity and healthcare industries continues to rapidly accelerate as we move into a more digitized future each day. The COVID-19 pandemic created a dire need for telemedicine as the standard way of healthcare practices. While the convenience of telemedicine and digital health practices seems obvious, the risks for liability and cybersecurity rise. OmniSure’s Executive Vice President Laura Luck Martinez [a](BSN, RN, MS, ARM, CPHRM, FASHRM) was a panelist at the PLUS Webinar this past October.

PLUS (Professional Liability Underwriting Society) is recognized as the primary source of professional liability educational programs and seminars, networking events, educational products, and information regarding professional liability. Martinez was a key speaker and presenter on the panel: The Dawn of Digital Healthcare: Wearable Technology – Risks and Strategies for Liability and Coverage with an esteemed group of other industry leaders. We explore some highlights and major takeaways from this webinar below.

Telemedicine affects everyone

Chris Tellner (Partner, Co-Chair of Healthcare/Managed Care Practice Group, Kaufman Dolowich Voluck, LLP) moderated the panel, and he begins with an excellent point: we are certainly in a new world, and technologies in healthcare have become extremely beneficial on both a personal and professional level. Beyond telemedicine and communication considerations, digital technologies are very personal: this applies to wellness and fitness goals that we commonly track with FitBits and Apple Watches.

This is where the security of digital healthcare gets cumbersome: there are extreme risks and pitfalls both on the professional liability side as well as the cyber insurance side when it applies to wearable technology. Aside from a personal attack and exposure risk of someone capturing confidential information, there’s an inherent risk for the companies to measure the data. Martinez explains the difference between wearable technology and medical technology.

Wearable technology v. medical technology

Telemedicine can be divided into three different modalities: real time, video, and asynchronous (“store and forward”). The latter is most commonly used in common practice (ie. dermatology) and allows for x-rays and video clips to be shared among primary care providers, in consults, etc.

A new form of technology has dominated healthcare: remote patient monitoring (applications and health records are triggered by Artificial Intelligence to create early intervention alerts to monitor and manage chronic health conditions). This significant advance in digital healthcare addresses common (and chronic) issues like: congestive heart failure, diabetes, post-op, oncology, etc. to be monitored.

Although they seem similar, there are differences between remote patient monitoring and telemedicine. They both have multiple capabilities to monitor glucose levels, track blood pressure monitoring, even apps that monitor air quality control (beneficial for anyone with respiratory problems). Laura explains the important differentiating factor: “[with the wearables] while we do see patient and physician self reported data, those devices don’t have medical grade validity in general…the wearables have different risk exposure and A.I. activity from telemedicine modalities…we see a higher risk exposure.”

Laura Luck Martinez elaborated how provider executives are investing massive amounts of money into AI technologies. The intention is for these systems to reduce spending over time and truly help patient outcomes.

However much money continues to be invested in AI, it is Martinez’s belief that not only will the remote patient monitoring devices be at great risk for some sort of breach, but all healthcare is at risk: the data, the systems, the devices we use to monitor and provide care for any patient in the healthcare setting.

Risk Management and Cyber Policies

There’s an incredible amount of risk involving cyber crime and insurance. Hackers could gain access to private and sensitive information. This includes: financial information, location, social security, physical condition, a person’s daily activities, political affiliations, credit risks, and much more.

The panel discusses how in today’s cyber world, we’re seeing all types of industries become victims of cyberattacks. From manufacturing to e-commerce businesses, everyone is at risk. Tamara Ashrin explores the dangers of ransomware in healthcare, and how this triggers so many different coverages under cyber policies and creates a slew of expenses.

In the professional liability realm, Ashrin gave an example of an inadvertent breach of privacy, which is definitely an area where companies need to know the risks and mitigations. She recalled an example of a nurse posting information on social media regarding a patient’s health where they were the victim in a city-wide event. The family of the victim sued the hospital for a privacy breach. One bad judgment can cost a company millions of dollars. Another common example of this social media/marketing use is a plastic surgery center posting “before and after” photographs of clients. Unless they obtain the patient’s consent, litigations may occur in those scenarios.

So, are there any products out there that provide resources to an insured claim without having to trigger coverage? Ashrin explains “…companies now provide training services and risk management services to policyholders that employers can use to train their employees to prevent breaches…these are typically available when you purchase the policy.”

Web of Regulations

A breach could implicate many types of regulations, including those involved with US Treasury Department regulations (office of foreign assets, US Sanctions list, etc.), HIPAA, Federal Trade Commission (important to be careful in obtaining and keeping data from wearable devices), FDA, etc. A recent example of legislation regulating this data is the California Consumer Privacy Act (CCPA) which covers businesses that collect and sell consumer personal information or disclose personal private data relating to California residents. The definitions of “consumer” and “personal information” are broadly defined.

What can policyholders, healthcare providers, or healthcare organizations do to protect?

Laura Luck Martinez emphasizes the absolute need for healthcare providers to include digital healthcare information in staff on-boarding. “…oversight and provider credentialing must be expanded…there’s a need to address the training, competencies, telehealth and remote patient management approachments. Ultimately, it’s incumbent on every single provider to have some knowledge of the credibility of the devices, it’s intended or promised functions. Relying on I.T. or other office personnel to know is not sufficient or adequate.”

This is crucial advice for any healthcare setting. Preparation is key: and this extends to back up plans as well. Martinez reiterates that “cyber security is a patient safety issue not an I.T. problem. We need to have business impact assessments and risk analysis – follow that with a strong development plan and program…there will be times when systems are down and data is unavailable. Preparation is key.”

The panelists advised the insurance companies to create a breach playbook, which identifies key personnel and responsibilities in the event of a breach or a suspected breach. Some other breach essentials include implementing a comprehensive backup plan, among other items of importance. Last but not least, the importance of knowing your cyber coverage resources is another key to mitigating risks.

What should a company do first in the case of a cyber attack?

This is a subjective question, but a few of the PLUS panelists responded to this question in a similar manner: they advised the victim to call a broker or carrier right away, and to not delete any information on servers. That being said, it’s an important reminder for businesses and companies to have data backed up onto other devices as well.

Looking into the future

OmniSure is a proud partner of PLUS, the global community for the professional liability insurance industry. Telemedicine, wearable tech, and the professional liability coverage implications remain at the forefront of the healthcare industry, and OmniSure’s Laura Luck Martinez remains a thought leader in that realm. We are committed to providing all of our partners with the most up to date industry risk mitigation standards and direction. Get in touch today to learn how we can help you and your company manage risk and elevate healthcare.

Full List of panelists

Presenters

  • Laura Luck Martinez (OmniSure Executive Vice President, BSN, RN, MS, ARM, CPHRM, FASHRM)
  • Abbye Alexander (Partner, Co-Chair of Healthcare/Managed Care Practice Group, Kaufman Dolowich, LLP)
  • Tamara Ashjan (Director, Claims, Cyber & Tech, Tokio Marine HCC)
  • Laura Ruettgers (Partner, Chair of Data Privacy & Cybersecurity PRactice Group, Kaufman Dolowich Voluck, LLP)

Moderator

  • Chris Tellner (Partner, Co-Chair of Healthcare/Managed Care Practice Group, Kaufman Dolowich Voluck, LLP)

Client Testimonial: Alan Hale, OmniSure Partner for 10+ Years

Alan Hale, Claims Committee Chair and founding member of Communities of Faith RRG, an Insurance Group, and the Executive Director of Manor Park (a retirement community), discussed how OmniSure has helped their business for more than 10 years. Because of the OmniSure partnership, the RRG was able to reduce claims activity and loss costs, they were able to measure and improve performance, and as a result their premiums came down at a time when industry premiums were increasing.

From carriers, to program managers, brokers, and policyholders, we are delighted to support our partners by managing risk to prevent losses, reduce loss costs, and improve healthcare. Watch the video below to learn more, and contact us today if your business could benefit from a partnership with OmniSure.

Helpline: Understanding the Risks of Patient Abandonment and How OmniSure Can Help Mitigate Risks

OmniSure continues to be a trusted partner to insurer and healthcare professionals for a myriad of reasons, but a distinguishable aspect is a 24/7 Helpline available to policyholders, brokers, and underwriters. If you are a clinician in crisis it’s extremely beneficial to have a live person answer an urgent call and connect you with an available risk and patient safety consultant. Read on to learn about one of the copious ways OmniSure’s Helpline supports in times of need, and what you can expect when you have any type of risk management predicament.

When to call OmniSure’s Helpline

OmniSure received a call from a nurse working the night shift in an acute care hospital under coronavirus pandemic conditions. Upon beginning her regularly scheduled work shift, she learned she had been exposed to two COVID-positive patients during her work shift 48 hours prior and that the policies and procedures for staff testing, quarantine, and masking had changed within the past 24 hours. Because she is immunocompromised, she felt she was in an unsafe work environment. As it happened, her manager was off duty and the manager on duty did not know about prior accommodations made for her health and well-being, and the Human Resources (HR) office was closed.

She began to feel panic and fear. Her self-preservation instincts were to leave work. However, her professional and ethical instincts led her to call OmniSure’s Helpline for guidance as she was most concerned about the risks of patient abandonment. As is often the case, having someone who is experienced but not emotionally involved in the situation to talk things through and develop a plan of action that is safe for the patient(s) and the clinician was just the support she needed.

Defining patient abandonment: What are your board’s regulations?

Many state boards of nursing address abandonment and provide guidance on what it is and what it is not. As a licensed and practicing clinician, it is your duty to know what your board regulations are, and to practice within these regulations. Allegations of patient abandonment against a nurse by an employer is an employment issue and not a professional liability issue or reportable to the Board. For example, abandonment is not a nurse failing to provide sufficient notice of termination, failure to return to work for an assigned shift, refusing to work in an unsafe or unethical environment, nor refusing to work mandatory overtime. These types of allegations are categorized as employment disputes.

Behaviors that have commonly been deemed as patient abandonment by state boards include: accepting a work assignment, establishing a nurse-patient relationship, and then leaving the unit or facility without notifying a qualified person, failure to perform assigned duties, or leaving without a proper hand-off or report to the oncoming shift. The key to determining what is and is not patient abandonment is commonly established by two criteria: did the nurse accept the assignment, and thus develop a nurse-patient relationship and, did the nurse end the relationship without appropriate notice to allow for the continued care and well-being of the patients?

How OmniSure Stepped In

In speaking with our early morning caller, we discussed what constitutes patient abandonment, the importance of notifying leadership on duty, completing medical record documentation, handing-off via a verbal report to another clinician, confirmed availability of sufficient and adequate personal protective equipment (PPE), and discussed what was necessary for her to feel safe and remain on duty to care for her assigned patients. We had two follow-up calls to provide support and answer further questions. We learned she had remained on shift and initiated discussions with her direct manager and HR to arrange a work environment that both protected her well-being and provided a safe work environment for the patients in her care.

We are Here to Help

This example of a Helpline call and the OmniSure response to support a healthcare professional to mitigate risk in real-time is the typical risk management support you can expect when you have a risk management question, or find yourself enmeshed in a situation that raises uncertainty. Do not hesitate to reach out or call 800.942.4140 for support when situations or questions about your professional practice arise.

An Exclusive Conversation with Carol Marshall on Reducing Risks, Providing Insight, and Authoring a Book

This holiday season, we are filled with gratitude for our wonderful team at OmniSure, who use their immense knowledge and expertise to ensure we provide the highest quality support to our clients. This month, we are highlighting Carol Marshall, MA, CCC-SLP (RET), QDDP, CALM. Not only is she a specialist in senior care, but she’s also worked with/in a variety of settings, among them: social services (adoption and foster agencies), school systems, developmentally disabled populations, and has even authored numerous articles and books. Fun fact: her most recent book was accepted into the Library of Congress.

We sat down for an interview to learn more about Carol’s role at OmniSure. In the spirit of her work and thanking those who care for the vulnerable, we have provided a free downloadable risk management for foster care article at the bottom of this article.

How did you start your career in the insurance industry?
Michelle Foster Earle started OmniSure by partnering with insurance industry leaders who wanted to reduce the risk of claims. Michelle and I had previously worked together as consultants with an organization which served long term care communities to help them comply with state and federal rules. It was an easy transition to place our compliance experience into the realm of risk management.

How long have you been with OmniSure?
18 years.

What does your job entail?
The best part of my job is working with facility-level managers. I meet with administrators and directors of nursing regarding systems that impact resident care, regulatory compliance, and relationships to fashion methods to reduce the risk of claims and lawsuits. I design training programs to foster customer service, implement quality improvement systems, examine new regulatory requirements, and create tools to set expectations for families and staff. I also author articles, books, create forms and in the past I have led sessions at various professional and industry conferences.

What inspires you the most about your work?
People. At the core of the best part of my job are the residents who need a living environment that makes sense, is safe and provides the best possible home-like setting. No one wants to live in a nursing home. I am inspired to make the elders’ living situation as best as possible by helping managers see the world through the eyes of the elders in their care. If I can help a manager take the day-to-day life of an elder in their care, and make it “just a little better,” then it has been a good day. By teaching managers to implement a few changes to impact the lives of the elders, and their loved ones, perhaps everyone will be a little better. The best compliment is when I hear, “That’s a great idea!”

What is your favorite part about working at OmniSure?
My managers and co-consultants are the best part of OmniSure. I have the freedom to be creative, search for new approaches, manage my own time, and communicate openly with my customers. And, I am not alone. There is a team of experts at my fingertips who are “the wind beneath my wings” and offer their expertise willingly and at a moments’ notice. OmniSure is built with experts from a variety of backgrounds, and all of them are experts in their field. I am humbled to be considered a member of such an illustrious team.

What’s the most unique part about working at OmniSure?
It is a unique company. What sets OmniSure apart from its competitors is the idea that we offer ongoing support and guidance for the duration of the facility’s insurance coverage. We do not simply identify areas to offer advice for improvement, and “move on.” We remain as a partner with the facility to address new issues as they arise throughout the coverage of the insurance policy. We have customers who have partnered with OmniSure for more than 10 years, who welcome our tools and resources. In this industry it is not unusual for managers to move from one facility to another. If one of our customers hires a new manager, that new manager is our customer for the duration of the insurance coverage. OmniSure is high-tech, and higher touch.

What is a fun or interesting fact about yourself that you wish people knew?
The Library of Congress contacted me and asked if they could include my latest book “SNF Risk Management Through Person-Centered Care” in the library. I am honored that someone in that organization likes what I have to say. So, that’s a fun fact: my most recent book was accepted into the Library of Congress.

Please share with us your biggest accomplishments at OmniSure.
Relationships with facility managers. Few people will rely on strangers when they are in a position to solve an issue, or ask for help when they feel like they need a life line. When my customers call and ask for a tool or help with a project, that is when I feel like I have accomplished my goal.

Please share anything else you wish to include about yourself or your role/time here at OmniSure.
My tenure with OmniSure has been the best part of my career.

Download OmniSure’s Foster Placement and Adoption Readiness Checklist and our Risk Mitigation for Foster and Adoption Agencies white paper today.

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