As the largest integrated health care system in Illinois, Advocate Health Care employs more than 30,000 associates—including 6,000 physicians and 9,000 nurses—at more than 250 sites of care, including 10 acute-care hospitals and two integrated children’s hospitals. Vice President, Risk Management and Insurance, and CLM Fellow Sarah Pacini describes how life in the ER helped her find her passion.
Q. Did risk management find you, or did you find it?
A. I began my career as a trauma nurse in the emergency department of a small local hospital. I always knew I wanted to be in health care, and the emergency department suited me perfectly. I enjoyed the high energy, common purpose, and strategic decision-making that I shared with my ER team.
After several years in the ER, I decided I wanted to attend law school to understand the issues driving health care change. I graduated from DePaul University with my Juris Doctor and a certificate in health law and went straight to the prosecutor’s office, where courtroom experience is available on a daily basis. After becoming an assistant state’s attorney, I was ready to return to my home in health care and blend my clinical and legal experience. Risk management was a natural opportunity and has been my niche for the last 10 years at Advocate Health Care.
Q. Do you have a philosophy to risk management?
A. My overall approach to risk management is somewhat similar to my approach to clinical care. I understand that organizations have unique environments with unique goals. To have an impact, it is important to understand the executive pursuits and enable the organization’s healthy trajectory toward those goals. This objective can be achieved through safety initiatives, risk financing, self-insurance, risk transfer, and litigation techniques.
Q. What’s a typical day like for you?
A. The daily risk management experience at Advocate Health Care is rarely routine. The department is responsible for the risk financing transactions, insurance, clinical risk management, workers’ compensation, litigation, and language services. This means each day is dynamic, especially in the new normal of health care reform. I find that the challenges of the changing environment are what make the role in risk management enjoyable. In order to be successful, today’s risk manager must be creative, collaborative, and a touch clairvoyant.
Q. What are some of your top exposures and claim types?
A. The risk management and insurance department at Advocate Health Care is responsible for the prevention, mitigation, and transfer of all risks. We also handle the litigation associated with said insurance or self-insurance. As you can imagine, the biggest risk exposure in a health care institution is hospital professional liability (HPL). Although one could easily identify that HPL accounts for the greatest financial risk, it also creates the greatest reputation risk. It is important for risk managers and litigators to recognize not only the exposure, but also its impact on the organization as a whole.
Although HPL is the typical type of claim with which we deal, there is little that is typical in HPL anymore. Health care reform has changed the legislative environment, and we are currently anticipating the judicial interpretation of the law. It has never been more important for risk managers to have an enterprise focus on their organizations in order to succeed.
Q. Describe your team. How do they help you succeed?
A. I am fortunate to have a phenomenal team of experts with whom I have the pleasure of working. The claims management team is an internal team that consists of five claims executives who have a total of over 65 years of claims management experience. Although we follow common litigation guidelines, each team member brings a unique perspective on claims management and litigation that is essential to a healthy program. In addition, our relationships with external counsel are critical to the success of our overall litigation strategy.