CPHRM key terms

A formal demand for compensation alleging that a health care professional's negligent act or omission caused patient harm. It may be resolved through negotiation, arbitration, or litigation.

A law setting the deadline by which a lawsuit or claim must be filed after an injury or its discovery. Missing the deadline usually bars the claim.

The pretrial phase in which parties exchange information, documents, and testimony relevant to a lawsuit. It includes interrogatories, requests for production, and depositions.

Sworn out-of-court testimony given by a witness or party before trial, recorded by a court reporter. It can be used to impeach testimony or preserve evidence.

A court order compelling a person to appear for testimony or produce documents. In health care litigation, it may request medical records or require a witness deposition.

A directive to preserve all potentially relevant documents and electronic data once litigation is reasonably anticipated. Destroying such evidence can lead to sanctions.

A legal doctrine allowing negligence to be inferred when an injury would not ordinarily occur without negligence and the instrumentality was under the defendant's control.

Money awarded to a plaintiff to compensate for harm, such as medical costs, lost wages, and pain and suffering. Punitive damages may be added for egregious conduct.

An unintended injury or harm to a patient caused by medical management rather than the patient's underlying condition. It may or may not result from error.

An event that could have caused harm but was caught or did not reach the patient. Analyzing near misses helps identify risks before injury occurs.

An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. The Joint Commission requires root cause analysis for such events.

A structured team process to identify underlying system failures that contributed to an adverse event or sentinel event, and to develop actions that prevent recurrence.

A proactive risk assessment method that identifies ways a process can fail, estimates the severity and likelihood of each failure, and prioritizes preventive actions.

A management approach that balances accountability with learning. It encourages reporting of errors, distinguishes human error from reckless behavior, and supports fair responses.

The shared values, beliefs, and behaviors within an organization that prioritize preventing harm. It includes leadership commitment, teamwork, and open reporting of safety concerns.

A preventable mistake in health care delivery, such as a wrong medication dose or a missed diagnosis. Errors may or may not cause patient harm.

A formal process of comparing a patient's current medication list with new orders at transitions of care to identify and resolve discrepancies and prevent medication errors.

The transfer of patient information and responsibility between caregivers. Standardized tools like SBAR help reduce omissions and misunderstandings that can lead to harm.

The process of verifying a health care provider's education, licensure, training, and experience to ensure they meet organizational standards for practice.

The authorization granted by a health care organization for a provider to perform specific procedures or services, based on verified credentials and competence.

A confidential evaluation of a clinician's professional performance by colleagues, used to assess quality, competency, and adherence to standards and to recommend improvements.

A systematic approach to measuring processes, identifying opportunities, and testing changes to enhance quality and outcomes, often using models like PDSA.

Comparing an organization's performance metrics against internal targets, industry standards, or best-performing peers to identify gaps and drive improvement.

Planning, training, and exercising to ensure an organization can respond effectively to disasters, epidemics, and other emergencies while maintaining essential services.

The four legal elements a plaintiff must prove in a malpractice case: duty, breach, causation, and damages. Failure to prove any element defeats the claim.

A legal obligation to act as a reasonably prudent health care professional would under similar circumstances, owed to patients and others who may foreseeably be harmed.

In negligence law, the failure to meet the applicable standard of care. Expert testimony often establishes what a reasonably prudent provider would have done.

The link between a defendant's breach and the plaintiff's injury. It requires proof of actual cause and, in many jurisdictions, proximate cause.

Legal responsibility imposed on an organization or supervisor for the acts of employees or agents performed within the scope of their duties, even absent direct fault.

A theory holding a health care organization liable for failing to maintain safe facilities, select competent staff, or enforce policies that protect patients.

The Health Insurance Portability and Accountability Act, a federal law governing privacy and security of protected health information and simplifying electronic health transactions.

The Emergency Medical Treatment and Labor Act, a federal law requiring hospitals with emergency departments to provide a medical screening exam and stabilizing treatment regardless of ability to pay.

Adherence to laws, regulations, and standards that govern health care operations, including licensure, privacy, billing, and patient safety requirements.

The amount of loss an organization chooses to bear itself before insurance or other risk transfer responds. It may be formal or informal and is a key risk financing decision.

A risk financing approach in which an organization sets aside funds to pay its own losses rather than purchasing traditional insurance, often managed with actuarial estimates.

A licensed insurance company owned by one or more organizations to finance their own risks. It can provide tailored coverage and access to reinsurance markets.

A liability insurance policy that covers claims for incidents that happen during the policy period, regardless of when the claim is reported.

A liability insurance policy that covers claims reported during the policy period, provided the incident occurred on or after the policy's retroactive date.

An extended reporting endorsement added to a claims-made policy that allows claims to be reported after the policy expires for incidents that occurred during the policy period.

A policy that protects a self-insured organization from catastrophic losses by reimbursing costs above a specified threshold, either per claim or in aggregate.