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Risk and Quality Management Manual

#Sample College Research Paper


            Risk and quality management have become indispensable in the contemporary healthcare setting. There is an increasing urge to solve the problems emanating from the aging population, financial constraints and the healthcare safety (Andersson, 2013). As a quality leader, one of the roles involve creating a manual for new employees to guide them in enhancing patient safety and to support the overall organizational goal of delivering safe, high-quality patient care as well as minimizing risks. Therefore, this manual will explain the basic concepts of risk and quality management in healthcare, and the challenges related with the decisions regarding the said concepts.

The Basic Concepts of Quality Improvement in the Health Care Industry

            The quality improvement is necessitated by some reasons like the demographic pressure, technological advancements, financial problems and the increasing expectations of stakeholders such as patients (Andersson, 2013). It is basically a collection of diverse models that aim at increasing the effectiveness and efficiency in the healthcare. It focuses on the present and future needs of the patients. In the classical view, quality improvement must take into account a continuous improvement, team work, focus on clients and achieve decision making by the guidance of facts (Andersson, 2013). To be specific, the goals of quality improvement in the healthcare industry is meeting the targets of safety care, being patient-centered, expertise, equal and effective in-time care (Andersson, 2013). Therefore, quality improvement calls for a change towards achieving the targets. As a matter of fact, quality in healthcare can only get achieved through a transformation from what the healthcare practitioners and the patients have been doing to attaining an effective service delivery. Such demands a strong support by the management, inevitable participation and the availability of necessary resources (Andersson, 2013).

            Apart from the quality improvement and change, there is also the concept of implementation. Usually, implementation is not viewed as a concept by itself in healthcare quality improvement since it is often coined with the improvement and change concepts. However, it is important for the management to consider the development of implementation strategies. Such strategies may comprise of the assessment and the registration of the quality of services through a proper communication and consultation among the stakeholders (Andersson, 2013). Equally important in regard to the achievement of implementation is the establishment of accountability framework. The framework will stipulate the regulations, objectives and the time frame of actions.

The Concepts of Risk Management in the Health Care Industry

            The concept of risk in the health care industries dates back to 1970 when the U.S court identified a corporate liability concerning the quality of healthcare services (Singh & Ghatala, 2012). This implies that a medical staff is liable for the quality of his/her services. Since then a formal program for all the U.S healthcare facilities requires an establishment of risk management framework (Singh & Ghatala, 2012). Studies inform that the U.S hospitals cannot be accredited unless the management presents the risk management framework. Such healthcare practices have also diffused to developing countries which depend on the healthcare training from the U.S government (Singh & Ghatala, 2012). It safeguards the practitioners from being the defendant in particular medico-legal lawsuits (Singh & Ghatala, 2012). As a result, in most modern healthcare the risk management has become an integral practice.

            Risk as a concept, refers to the uncertainty of actions (Berg, 2010).  It is unavoidable and in most cases found in almost every sphere of human endeavors. Risk management refers to a systematic technique that concerns the identification, evaluation and mitigating the actual and potential risks (Berg, 2010). It specifically derives mechanisms to safeguard the assets and at least minimize financial misappropriation. Therefore, risk management requires pro-activity to curtail the frequency of unexpected incidences, legal claims and initiate reliability and coverage enhancements amongst others (Berg, 2010). The risk management in healthcare industry involve the appointment of a risk manager who integrates the priorities of this program. With regard to the in-patient situations, the personnel are normally referred to as the quality manager, while in the outpatient setting he/she is the head nurse or the office manager (Singh & Ghatala, 2012).  It is important to make the risk management integrated and not at a practitioner level.

The Decision-making Processes in Risk and Quality Management in the Health Care Industry

            The risk and quality management in the healthcare industry encompasses the development of a statement of standard (Health Service Executive, 2007). Such gets achieved through the achievement of an integrated quality and risk management systems to ensure a constant quality improvement (Health Service Executive, 2007). Thus, it begins with the derivation of essentials of managing risks from which the improvement gets developed. To begin with, the risk manager must get the support from the medical staff, CEO, government institutions and the patients (Singh & Ghatala, 2012). Also, the risk officer should monitor various departments to enhance an effective performance. Another significant step in the health care risk and quality management is the adherence to the following steps:

            First, there is need to identify the situations in the healthcare that would cause financial losses in future (Singh & Ghatala, 2012). Thus abnormal incidence reporting must become a prevalent practice within the healthcare. Like in the business perspective, the risk managers can also develop a check list to determine the possible risks. Second, the risk management should ensure an evaluation of the event reports for a certain time frame, six months for example (Singh & Ghatala, 2012). After this evaluation the information obtained is compared to the occurrence of incidences in different hospitals to help in the determination of the probability of happening. If an event has a high likelihood of occurring the management develops an improvement strategy. In this case a preventive strategy will help to minimize the impacts of an event. Thirdly, there is also the need to eliminate trivial procedures within the healthcare premises. Some procedures like the sale of items may result in a law suit (Singh & Ghatala, 2012). Additionally, complex procedures especially bureaucratic can result in reporting delays.

            Further the fourth procedure is the incorporation of insurance services to enhance the comfortable environment in consideration to healthcare operations. Hence the risk and quality management in healthcare entails the acquisition of insurance coverage (Singh & Ghatala, 2012). Healthcare administrators can take a combined insurance cover to ensure that the process becomes cost-effective. Actually, this is a prevalent practice in most industries like the transport and the business-related operations, only to mention a few. Lastly, it is crucial for the management to hold ‘found harmless’ agreement with the institutions which manufacture drugs and equipment (Singh & Ghatala, 2012).        

Moreover, the risk and quality management requires the establishment of an effective complain mechanism (Singh & Ghatala, 2012). The risk managers should examine the claims and rectify the negative concerns. Typically, the process of improvement includes the correction of the past mistakes to attain a more satisfying product. Equally important is the conduction of the standard based workshops among the medical staffs (Singh & Ghatala, 2012). Failure to train healthcare practitioners eventually results to malpractices. Reports rank this as the second among the common factors resulting in a sentinel event (Singh & Ghatala, 2012. The training of staffs bears some benefits like it propagates the attainment of quality in healthcare facilities. Also, this training enhances team work among the medical staff, a factor that facilitates the achievement of regular reporting of the operations. A similar approach is creating awareness campaigns to inform the public what is expected of the patients. It is again crucial to ensure that a health facility has adequate staffing.

            Further, the general hospital management is advised to incorporate clinical governance in the operations (Simone & Esposito, 2014). It promotes four types of qualities namely; medical professional quality, targeted quality, efficiency and the risk control (Simone & Esposito, 2014). In particular, the clinical governance guides the healthcare practitioners in exercising a considerable level of professionalism in performing diagnostic, therapeutic and other medical related procedures (Simone & Esposito, 2014). It mainly advocates for the scientific based tests and evidences through the most cost effective mechanisms. It is thus important in the reduction of human errors in the treatment of patients.

The Challenges Facing the Risk and Quality Management Decisions in Healthcare Industry

            Despite the risk and quality management efforts being made in the healthcare industry, still there is a lot demanding an extra improvement. There is arguably a varying performance among the healthcare units and the healthcare status in different regions. Incidence reporting as a procedure of identifying the risk is hindered by the fact that most healthcare professionals especially the doctors are reluctant to report a funny occurrence to their superiors (Singh & Ghatala, 2012. This promotes the prevailing of human errors in regard to the treatment of the patients. Also the effectiveness of malpractice related complaints depend on the level of development of a country. In the developing world, such claims are relatively ineffective. For example, the medical doctors in India do not provide a holistic witness as required by the law but instead favors fellow practitioner. In case a doctor becomes a witness in a court, several doctors ensure a presence in the court to intimidate the evidence (Singh & Ghatala, 2012. The implication is that the clinical governance gets hindered and more specifically, the professionalism quality.

            Still, there is a challenge of geographical diversity which means that the comparison of different hospital situations may not yield the likelihood of an event. This hinders the assessment of risks and consequently may result in risk management failure. Also, the differences in economic development make it difficult to derive a specific amount of resources that should be allocated for a certain level healthcare (Freel, 2012). Some countries do not even have experts of particular field of treatment or at least they lack funds to equip hospitals with necessary equipment. Studies reveal a significant shortage of health care professionals, a factor that transpires to reduction in quality and delay in treatment (Freel, 2012). Therefore, in such countries decision making to achieve quality gets curtailed.

            Also, there is a problem of managing subsidized medical programs like the Medicaid and Medicare in the United States. Due to the increasing number of the unemployed, the healthcare administrators face a challenge of providing treatment services and at the same time keep fiscal responsibility (Freel, 2012). Besides, some healthcare administrators are only concerned with earning money and not the quality of their services. This makes it difficult to ensure the quality across the health facilities. Many of these doctors have turned health care units as businesses though even in the business world customer satisfaction is the key to ensuring the quality of services.


            The achievement of the statement of standard is the key to enhance quality improvement in healthcare (Health Service Executive, 2007). It begins by the determination of risks through the assessment of the probability of risk occurrence. After that, improvements can be made to ensure the satisfaction of the stakeholders. In-time and equal treatment are the major targets to achieving quality healthcare (Andersson, 2013). To achieve such, the healthcare administrators should exercise clinical governance that brings professionalism and the service quality. However, there are numerous challenges affecting the risk and quality management which therefore calls for further research and action by the concerned parties to mitigate them and uphold patient safety.

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Andersson, A. (2013). Quality Improvement in Healthcare: Experiences from a Swedish County Council Initiative. Linköping Studies in Science and Technology Dissertations, No. 1505,   1-133.

Berg, H. (2010). Risk management: Procedures, Methods and Experiences.1, 1-17.

Freel, M. (2012). 5 Challenges Hospital Administrators Must Overcome to Succeed in Today’s Rapidly Changing Industry. Becker's Hospital Review. Retrieved from challenges-hospital-administrators-must-overcome-to-succeed-in-todays-rapidly changing-industry.html Health Service Executive (2007). Quality & Risk Management Standard. 1-23.

Simone, S., & Esposito, A. (2014). The Risk Management in Italian Healthcare Organizations Threats become Opportunities. American International Journal of Social Science, 3(3), 15.

Singh, B., & Ghatala, H. (2012). Risk Management in Hospitals. International Journal of  Innovation, Management and Technology, 3(4), 1-5. Retrieved May 1, 2016.



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