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Erica Hoffman

Communications Intern

The Key to Risk Management? Asking Questions.

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Red arrow signs pointing uptooward the sun. One sign reads "Risk Management."

So many life successes depend on asking the right questions. In fields like education and science, the benefits of good questions are immeasurable. They help you understand. They help you remember. They help foster deeper reflection and better our learning processes. That is exactly why asking questions — a lot of them — is so crucial when assessing patients who may be in greater need of risk management.

Risk management is the culture, processes and structures in place to help us recognize and understand the potential for adverse effects, according to Ron Zimmet, attorney and general counsel for the Mental Health Risk Retention Group managed by Negley Associates. As the quality of risk management improves, so does the quality of patient safety and care.

And since patient safety and care should be every provider’s top priority, we must ask, “How exactly do we improve risk management quality?” Each of the following steps is critical in asking the right questions:

  1. Determine specific risk factors and how they relate to mental illness. Despite sensational news stories and lurid headlines, we know that mental illness does not characteristically correlate to increased violence. We also know that the presence of violence at the outset is an indicator of higher rates of repeated aggression. Factors you should consider include gender differences and medical history. Does this patient have a history of aggressive behavior? A history of child abuse or domestic violence?  Of substance use disorder or dependence? Antisocial or borderline personality disorder? Co-occurring disorders? All these factors are strong predictors of the level of risk management needed. 
  1. Document details in a narrative form. This enables your thoughts to flow and makes it easier for the next evaluator to do the same. Because such documentation acts as a health information resource to you and all future evaluators, it is critical to sufficiently detail what you observed. For example, when a patient is experiencing auditory hallucinations, it is not enough to ask when and how often they occur. Instead, take a detail-oriented approach and ask questions like: “What do they say?”  “What happens just before you hear the voices?” “Do they come from inside or outside of yourself?” “Have you ever acted on them?” “Does anything stop them?” These and similar questions will help you understand the violence risk level.
  1. Be a detective. In addition to asking an exhaustive list of questions, maintain healthy skepticism regarding what you hear from your patient. Ask questions, but also talk to all relevant people, reviewing pertinent records and engaging with other sources to compare with one another will help maintain your objectivity.
  1. Use checklists. Sophisticated checklists like the HCR-20V3 — a time-efficient, cost-effective and reliable screening checklist — can help you ask the right questions. They address and help you correct flaws in memory, attention and thoroughness.

To protect our patients, our workplaces and our communities, it is imperative that we increase our efforts to improve the quality of risk management. Communicate, collaborate and question. After all, there is no such thing as a dumb question. Every question is a cry to better understand the world.

What do you and your organization do to ensure quality risk management? Let us know below, or Tweet your thoughts using the hashtag #BH365.

For more information on risk management, check out our webinar with Mental Health Risk Retention Group/Negley Associates. View the slides and listen to the recording at your leisure.