Why do we need both risk management and quality improvement efforts in our health care facilities? A simple comparison of the words “risk” and “quality” could shed light on this subject.

“Risk” denotes something bad: a fall, a slip, or an accident. These all signify danger, threats, or jeopardies. By replacing the word “risk” with these bad events, we then have “fall management,” “accident management,” or “danger management.” Scary things need to be managed in order not to happen again.

Quality, on the other hand is good. It indicates excellence, superiority, the best of the best. Residents in a long-term care facility or patients in a hospital want to have “quality” of life, “quality care,” “quality food” and “quality service.” Replacing the term “quality,” gives us “life improvement,” “care improvement,” or “service improvement.” Good things can get better, so let's improve them!

Even more interesting is flipping the terms “risk management” and “quality improvement.” “Risk improvement” is an oxymoron. Who would improve a danger or a threat? While quality management signatures keeping quality at the status quo: It's good enough, just manage it. To simplify the terms, with risk management, we manage the bad so it does not happen again; with quality improvement, we improve the good to make it better.

In a health care environment, risk management focuses on threats or harmful situations through identification, analysis, reduction, and prevention. Quality improvement centers on performance and ways to improve that performance based on standards, which are always being reviewed and enhanced. Both are essential in any health care situation. Both programs work cooperatively to provide a safe environment and a high standard of patient care.

The similarities and differences of risk management and quality improvement play important roles in maintaining a clean, safe, and healthy facility. Both have different objectives, scope, and approaches, but when looking at the activities of both in a complex health care setting, risk management and quality improvement are actually more similar than different. Because each share a common agenda of preventing adverse occurrences, the combined effort of the two realizes the most benefit to the facility in terms of patient safety and satisfaction, prevention of patient-related injuries, cost effective use of resources, and integrated administration and clinical activities.

By integrating quality improvement with risk management, everyone at the facility-from the administrators to the doctors to the staff to the family members-work together to improve the quality of care and avoid litigation from threats in the facility environment. Risks such as incorrect falls, malnutrition and dehydration, adverse drug events, pressure ulcers, wandering and elopement, inadequate documentation or failure to record treatments, and overuse / misuse of psychotropic medicines, are unavoidable even in the best of circumstances. Such issues are often complicated with understaffing, poor quality of care, and inaccurate or incomplete transfer of information to and from the acute care setting.

To address those issues-such as staffing, care, and communication-that can be improved, the facility must establish a culture that keeps its staff accountable and dedicated to continuously improving standards, operations, and quality of care. Staff also must have proper reporting and feedback processes, and specific guidelines for handling emergencies and investigating events. In essence, every member of the facility must be dedicated to the practices in place for a safe and healthy environment for its patients or residents.

Quite simply, managing risk and improving quality work hand-in-hand to provide patients and residents in health care facilities the safest, cleanest, and extremely the best environment. Both risk management and quality improvement are equally important endeavors and both must be on every health care facility's high priority list. Having these programs in place demonstrates to the patients, the residents, their families, the facility staff, and the community that the organization is committed to its missions and values. Thus when and if an incident occurs, the organization can manage it most effectively with the best practices of both risk management and quality improvement.