A defining moment in Candace Zanelli’s career came not from a hospital boardroom or a training session, but from a personal healthcare crisis that she experienced as a 21-year-old, brand-new mother. As a NICU nurse, she recognized immediately that her newborn daughter was blue and aspirating. But her concerns were dismissed by the medical team tending to her. Three days later, a chest X-ray revealed that Zanelli’s daughter had pneumonia—and she spent the next three weeks in neonatal intensive care.
This experience underscored the importance of effective communication and responsive care for Zanelli. “If they had just properly assessed her when I spoke up, it would have made a big difference,” she says. This personal ordeal shaped her approach to risk management, driving her to ensure that no other parent would face the same fear and frustration she did.
Zanelli now works at Bingham Healthcare in Idaho, which has developed a comprehensive risk management (RM) program. Led by Dr. Kenneth Newhouse, Chief Medical Officer, and Zanelli (who now has the title of RN Risk Manager), the program is developing forward-looking strategies to address and mitigate risks.
Their approach seeks to create a culture of safety, continuous improvement, and collaborative problem-solving. Through targeted risk assessments, innovative training methods, and a commitment to zero harm, Bingham Healthcare has made significant strides in enhancing patient safety and staff satisfaction.
Risk management: Playing offense and defense
Dr. Newhouse sees risk management as both proactive and reactive. “I think of risk management as a way to apply both ‘offense’ and ‘defense,’” he says. “The ‘offense’ is having good policies and procedures using best practices. The ‘defense’ occurs after something bad happens."
Initially, the concept of risk management at Bingham Healthcare met with apprehension among some employees. As Zanelli says, “At first my colleagues were afraid of risk management. It sounded too much like punishment for doing something wrong. So, we worked to make that experience one of support and problem-solving.” To do so, Bingham shifted the focus from errors in team or individual performance toward creating a more engaging and supportive environment.
For instance, one change was to rebrand “root cause analysis” meetings as “performance improvement” meetings. This helped reduce the negative connotations associated with these meetings, making them more about collaboration and less about blame. “We wanted to make them informative, educational, and a place where people could present their case without feeling they would be retaliated against,” says Zanelli.
Building a safety culture
Creating a culture of safety at Bingham Healthcare has been a cornerstone of their RM program. Dr. Newhouse says that setting a high bar for safety standards as advocated by healthcare leaders such as Mark Chassin, the former CEO of the Joint Commission, is a big step toward creating greater patient safety.1 “It may not be possible to reach the goal of zero errors,” Dr. Newhouse says. “But really, that’s the only acceptable goal.”
One part of the medical world that works against a strong safety culture is its historically hierarchical structure. Traditionally, physicians are at the top of the ladder, and at each step down there is someone who is typically treated with a little less respect. That must change. “The cleaning crew should be able to walk up to a physician with a question or comment,” Dr. Newhouse says. “Everyone needs to feel empowered to speak up.”
The value of risk assessments
Risk assessments have proven invaluable for Bingham Healthcare. When Zanelli started her role there, she discovered that Physicians Insurance had recently completed a comprehensive risk assessment report, which had yet to be acted upon. The report helped provide a clear roadmap for addressing key risk areas.
And it’s worth noting that risk isn’t always strictly a medical issue. One of the biggest challenges Bingham Healthcare had faced was the constraints of a dated facility. The hospital, built in the 1950s, required great effort to accommodate modern healthcare needs, such as managing the unpredictability of workplace violence. The hospital conducted drills and prepared staff for potential scenarios in order to reinforce safety practices that resulted in significant improvements.
Zanelli is also working to improve the grievance policy, ensuring that all complaints are addressed promptly. “Everybody gets a prompt call back after filing a complaint,” she says. “We need to listen to patients and families to improve care quality.”
Finally, to help create a more collaborative environment, Bingham Healthcare transformed its approach to RM meetings. These once-contentious meetings are now seen as opportunities for team-building and problem-solving.
Looking ahead: Challenges and opportunities
As healthcare evolves, Bingham Healthcare is working to meet future challenges such as integrating artificial intelligence (AI) into healthcare and addressing staffing shortages. Dr. Newhouse acknowledges the complexity of modern medicine and the potential impact of AI. “I don’t know if AI is going to be a good thing or a bad thing to medicine,” he says. “The jury’s still out on that.”
Maintaining a strong RM program also requires continuous improvement and adaptation. Zanelli says it’s important to create a culture where staff feel valued and motivated to stay, and where they can contribute to continual improvements.
Bingham Healthcare’s journey in risk management offers a valuable blueprint for other medical institutions. By encouraging a culture of safety, leveraging risk assessments, and transforming its approach to risk management, Bingham Healthcare has created a robust program that mitigates risk while improving patient care and staff satisfaction. As Zanelli says, “The approach that cultivates an effective risk management program is that mistakes are not crimes to be punished, but puzzles to be solved.”
1 Joint Commission Overview: Mark R. Chassin, MD, FACP, MPP, MPH, President & CEO (youtube.com).
More Member Case Studies
Missed-finding Allegations and Hindsight Bias in Radiological Malpractice Suits
Why Risk Assessments are an Important Resource