Go to EC.9.10 for guidance in monitoring the EC
When it comes to a list of items to monitor in the EC, the starting point is element of performance #1 under EC.9.10:
- Injuries to patients or other coming to the hospital
- Incidents of property damage
- Occupational illnesses and injuries to employees
- Security incidents involving patients, workers, or others
- Hazardous materials and waste spills, exposures, and related incidents
- Fire safety management problems, deficiencies, and failures
- Medical equipment management problems, failures, and user errors
- Utility system management problems, failures, or user errors
Now there's a whole lot of risk that lives in these bullets above. Thus, the acid test becomes one of risk recognition, assessment, intervention, and ongoing performance monitoring.
An increasingly critical function of the survey process is the risk assessment portion and then the quality of the interventions that you choose to manage the risks.
Requirements for improvement in the EC are up, not so much because there are significant program failures, but rather because of a whole bunch of minor deficiencies that are aggregated into serious findings.
Mix this in with each member of the survey team being responsible for finding stuff and you have the oft-cited recipe for disaster.
Ultimately, the onus is on each organization to define what these EC risks mean and then defend the risk management approach they've chosen.
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