Risk Insider: Terri Nichols

A Culture of Risk Management

By: | August 11, 2014 • 2 min read
Terri Morris-Nichols is system director of risk management at PeaceHealth, a not-for-profit health care system with 10 hospitals and medical facilities in Alaska, Washington and Oregon. She is a registered nurse with a master's degree in health administration. She can be reached at [email protected]

My favorite definition of culture goes something like this: the arts and other manifestations of human intellectual achievement regarded collectively.

We think of culture as the customs, ways of thinking or behaving in a particular society or group. It can be said then that there is an art in the design, implementation, and sustainability of an organization’s risk culture, and that there are ways of thinking and behaving as it relates to how an organization understands its relationship to risk.

It’s about everyone in the organization identifying risks, participating or contributing to mitigation planning, and recognizing the thresholds the organization holds in regard to risk (for example, by risk mapping).

In a risk culture, the impact that each of our employees has as a result of their contributions to the culture cannot be underestimated. The importance of how the risk culture is nurtured and cultivated by all levels of committed leaders is paramount to setting the tone and influencing risk behaviors … behaviors that demonstrate an understanding of the inter-relationship and impacts of risks which in turn creates the culture of risk management.

In health care, think about the team member from housekeeping who sees patients every day who are at risk from some of our practices. What about the phlebotomist who must understand the risks related to restraints when they draw patient samples for testing? How much could we learn from the chaplain who hears our patient’s fears and concerns about their environment while hospitalized?

These team members contribute so much to a risk culture if we have the communication structure necessary to bring ideas and recommendations forward.

All too often, risk management is identified as the place you go when there is a claim or litigation (once related to me as a call to the principal’s office), or when you have in-the-moment crisis management needs.

However, creating an infrastructure of a successful risk culture begins early — at the job candidate interview process — and continues through the employee’s stay with the organization.

I once asked a candidate to describe their comfort with risk taking, and they described how they would take any risk — whatever the cost — to do what was right for those they would serve. Without parameters that are linked to the organization’s mission, values, and structures, this candidate would have put the organization at a level of risk we were not willing to accept.

Orientation — we use a game called “Risk Jeopardy” — is a great place to practice examples of risk taking as it relates to the organization’s policies and individual employees.

Rewarding new employees who bring a concern to risk management can also help establish the infrastructure of the culture.

As leaders are developed to be more aware of the value of risk management (through opportunities such as risk mapping), they will include risk management in strategic processes related to new programs and services, and day-to-day risk sharing opportunities and operational decision-making can become an approach to success.

Read all of Terri Nichols’ Risk Insider contributions.

More from Risk & Insurance

More from Risk & Insurance

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.


That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.


Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]