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Reducing Risks Facing a Healthcare Organization

Healthcare organizations have a vital role in ensuring that nations have healthy populations. The organizations’ management teams influence their effectiveness in delivering services to their clients. Hospitals and other healthcare institutions face various challenges regarding how to avoid and minimize risks. Therefore, the management team led by the Chief Executive Officer (CEO) should optimally utilize limited resources (money, time, and energy) to manage the ever-increasing threats. They must ensure that all their organizations’ departments align their risks assessments to the most critical areas to achieve business objectives and strategic goals while maintaining compliance with seat regulations. Some of the risks faced by healthcare organizations are related to Health Insurance Portability and Accountability Act (HIPAA) privacy and security, legal and regulatory compliance, cybersecurity, emergency preparedness, clinical quality, and patient safety. Hiring qualified staff and training them, policies’ formulation and implementation, and ensuring compliance to regulations are important concrete strategies a CEO can use to minimize the risks.

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The adoption of technology in healthcare organizations increases the risk of violating the HIPAA requirements. The United States Department of Health and Human Services (HHS) enforces the HIPAA privacy and security rules in the healthcare system. These rules and regulations require hospitals to protect patients’ health information, such as medical records. According to Argaw, Bempong, Eshaya-Chauvin, & Flahault (2019), factors such as access to protected health information’s databanks, artificial intelligence, and personal health monitors increase the risks for data breaches and cyberattacks. The CEO can minimize the risk by training the staff on how to ensure only authorized individuals have access to protected health information. Additionally, the installation of modernized cybersecurity infrastructure and regularly performing risk assessments can ensure compliance with the HIPAA requirements. These strategies will not only protect patients’ health information but also minimize the possibility of the healthcare organization facing legal litigation.

Healthcare organizations face the risks of noncompliance to set rules and regulations. Undeniably, the healthcare industry remains the most regulated sector with special federal and state laws. According to Chen et al. (2020), these rules apply to physicians and the health care system to avoid unnecessary referrals of Medicare patients and fictitious or inaccurate claims to Medicaid or Medicare beneficiaries. Noncompliance with the federal and state regulations can lead to a lawsuit and significant financial consequences. The CEO can reduce the risk of legal and regulatory noncompliance by ensuring that all employees know the set laws and regulations to combat abuse and fraudulent activities. This can be achieved by encouraging them to regularly review the federal and state regulator websites. Equally, the CEO can download copies of the regulations and provide them to the staff. The establishment of a proactive mechanism for auditing billing, claim to code, and physician transactions can also be an instrumental approach for lowering non-compliance risks. The CEO should also periodically review the efficacy of the organization’s compliance program to prevent legal action by the regulators.

Cybersecurity has been a growing concern for healthcare organizations’ management teams due to the increased use of technology-enabled communication and cares for the patients. The tread increases the risk for cyberattacks from malicious individuals, leading to unauthorized access to sensitive patients’ intimation as well as violations of patients’ privacy. A healthcare organization’s CEO can alleviate the threats for cyberattacks by designing and implementing guidance for cybersecurity programs that focus on identifying, detecting, responding, and applying protective controls to security risks (Argaw et al., 2020). Inadequate preparedness for spotting and reacting to cyberthreats within healthcare organizations is also a significant concern. The CEO can address the issue by installing technology and hiring qualified and experienced personnel to facilitate effective monitoring of the organization’s networked system for any intrusion.

The increasing demand for clinical quality and patient safety is also accompanied by considerable risks that healthcare organizations may encounter. Payments models in the healthcare sector have shifted towards value and are based on the quality of provided services. Additionally, regulators and federal and state levels demand that health care entities quality measures. Lack of or ineffective processes for offering and enhancing quality care increase the risks for adverse patient outcomes and deteriorating reputation and financial performance (Kruk et al., 2018). Conversely, clinical processes, ranging from communication and care administration, are associated with significant patient safety risks. The CEO can develop and implement training programs that focus on improving clinical quality and patient safety. It is imperative to ensure effective communication and collaboration among healthcare providers and between the latter and patients and align all clinical processes with evidence-based practices (Kruk et al., 2018). These strategies will guarantee quality services, patients’ and better patient outcomes, promoting the organization’s reputation and financial performance.

Another risk faced by healthcare organizations is unpreparedness for human-created or natural disasters. The latter causes an accelerated influx of patients, straining available and limited resources. However, a healthcare organization’s CEO can minimize the threats by developing an emergency plan using risk assessments, supporting procedures and policies, and an effective communication plan with local and state health departments (Fischer, Halibozek, & Walters, 2019). Additionally, the leader should train staff and conduct drills to guarantee the safety and wellbeing of existing and new patients as well as that of care providers during emergencies.

Operations of healthcare organizations are associated with numerous risks associated with HIPAA privacy and security, legal and regulatory compliance, cybersecurity, emergency preparedness, clinical quality, and patient safety. The CEO has a vital role in designing and implementing strategies to reduce the risks. The approaches that they may use range from hiring qualified staff and training them to formulate and implement policies to ensure compliance with federal and state regulations.

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References

Argaw, S. T., Bempong, N., Eshaya-Chauvin, B., & Flahault, A. (2019). The state of research on cyberattacks against hospitals and available best practice recommendations: A scoping review. BMC Medical Informatics and Decision Making, 19(1), 1-11.

Argaw, S. T., Troncoso-Pastoriza, J. R., Lacey, D., Florin, M., Calcavecchia, F., Anderson, D.,… Flahault, A. (2020). Cybersecurity of hospitals: Discussing the challenges and working towards mitigating the risks. BMC Medical Informatics and Decision Making, 20(1), 1-10.

Chen, Z. X., Hohmann, L., Banjara, B., Zhao, Y., Diggs, K., & Westrick, S. C. (2020). Recommendations to protect patients and health care practices from Medicare and Medicaid fraud. Journal of the American Pharmacists Association, 60(6), 60-65.

Fischer, R. J., Halibozek, E. P., & Walters, D. C. (2019). Contingency planning emergency response and safety. Introduction to Security, 249-268.

Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S.,… Pate, M. (2018). High-quality health systems in the sustainable development goals era: Time for a revolution. The Lancet Global Health, 6(11), 1196-1252.

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