The PBH Quality Improvement Program includes mechanisms for
reviewing potential incidents of risk and safety concerns
at a member-level. PBH personnel are responsible for identifying,
reporting and documenting risk management and potential quality
of care problems that impact the clinical safety of the member.
Effective strategies for proactively reducing errors and ensuring
patient safety require an integrated and coordinated approach
to synthesize knowledge and experience for the management
of actual and potential risks. Activities should encourage
learning about errors and permit internal reporting of what
has been found, actions taken to reduce risk, and a focus
on process and system improvement that minimizes individual
blame. Oversight of such investigations occur at the regional
level and potential risk management issues are reported to
the PBH Legal and Regulatory Affairs Department, when appropriate.
Risk management issues are monitored at a regional level through
the Quality Improvement Committee including:
Monitoring areas of potential clinical risk for members,
assure safety of members, and take action, when necessary.
Ensuring those complaints or concerns about quality or
appropriateness of services are investigated and that appropriate
corrective actions or interventions are implemented.
Ensuring that patient safety activities are established.
Ensuring that operations are compliant with local regulatory
practices.
Monitoring the process for ensuring the quality of care
and altering the conditions for provider participation with
PBH through peer review.
