This Health Care Risk Manager Wants the Industry to Look to ERM for Better Business Solutions

Rebecca Cady at Children’s National is keeping on top of the growing risks impacting health care, including cyber security, reputational risk and maintaining vendor relationships.
By: | December 11, 2018 • 5 min read

R&I: What was your first job?

My first job out of college was as an emergency room nurse at Johns Hopkins Hospital in Baltimore.

R&I: How did you transition from nursing to a career in risk management?

During my second job, which was on a high-risk obstetrics unit, a couple of my coworkers became involved in a lawsuit. They were really upset, and it didn’t seem like the attorney who was defending the hospital had a lot of empathy for how it felt to be a nurse involved in that situation.


I’d always known I was going to go to graduate school, and I was in the process of figuring out what I wanted to do. It occurred to me that an attorney should have a better understanding of what it’s like to be a health care professional in that position. I could be that attorney. So, I decided to go to law school and have helped to manage risk and provide defense for health care providers ever since.

R&I: What’s been the biggest change in the risk management and insurance industry?

In health care, it’s the complexity of relationships between various health care providers and vendors. The risks have expanded and become more complex, especially with respect to cyber issues.

As we get more dependent on technology and the Internet of Things, some of the vendors we have to work with are very small companies, and they don’t necessarily have the right IT security infrastructure in place, and they definitely don’t have the insurance in place. But we have little negotiating leverage, because these vendors provide services our business partners in the hospital tell us they really need.

It’s a colossal risk for us. We’re not really worried about the routine medical malpractice case anymore; we’re worried about some hackers taking over our IV pumps. The risks have gotten more complicated, and therefore, the coverage we need has become a lot more complicated.

R&I: What are some trends or changes you’re watching specific to health care?

Case severity seems to be going up. Reputational risk is also increasing, thanks to social media. Anybody can get online and make salacious accusations that can go viral in minutes. In the court of public opinion, people are judged before you have a chance to defend yourself. It’s impossible to fully prevent that from happening, and when it does happen, responding to it is challenging.

R&I: What’s the biggest challenge you’ve faced in your career?

Reshaping our program after we had a major leadership change in 2012, when our new CEO came on board. I had a lot of support, so it turned out great. Personally, it’s challenging to keep up with all the change and to make sure that you’re up on the latest trends and the proposed laws and the complexity and interconnectedness of it all.

One of the toughest tasks is keeping your workforce educated on all the risks, because one employee can bring your whole company down in terms of your IT systems or publicizing some event that goes viral. You have to hire the right people, set expectations about behavior and hold people accountable and keep up with things as they change. It’s a little like drinking from a fire hose.

R&I: What role does technology play in your company’s approach to risk management, and how do you think technology will continue to shape the industry?

Tech can be very helpful and also very risky. It has helped us work smarter versus harder in some respects. Incident reporting is one example. The systems are so much better than they used to be; we even have a mobile app for staff to use in the building, so they can very easily and quickly complete an incident report.

That makes a big difference. We also have the ability to mine the electronic medical record for potential unreported events, which we call trigger reporting. We’re also using simulation training to train providers for crisis scenarios.

R&I: Who is your mentor and why?

Rebecca Cady, VP, chief risk officer, Children’s National Health System

Since I’ve been here, my boss Mary Anne Hilliard has been a big mentor to me and has been a pioneer in health care risk management and patient safety.

R&I: What advice might you give to students or other aspiring risk managers?

Two points: One, always have a curious mind. Know what you don’t know and don’t be afraid to ask questions. And two, don’t underestimate the importance of relationship building in doing risk management work. To be a successful risk manager, you have to be viewed as a business partner and an enabler of decisions — not the Department of No.

R&I: What are your goals for the next 5 to 10 years of your career?

I would like to be one of the pioneers in solidifying ERM in health care. We’re way behind other industries in terms of our sophistication and implementation of real ERM, and I’d like to be one of the first to get that done in my organization and prove the business case for it. So hopefully 10 to 15 years from now, ERM will be as mature for health care as it is for, say, the financial industry.

R&I: Why is health care lagging in ERM sophistication?


e’ve been very focused on patient safety, and rightly so, but a lot of the things that we’ve done to make care more safe and reliable — those same principles apply to the business aspects, but we haven’t really taken stock on the business and operations side of the house.

R&I: What is the most unusual/interesting place you have ever visited?

Morocco. I was there for vacation; we went to visit our daughter who was doing a semester abroad. I’d never been to Africa. Things there were just so ancient and actually very well-preserved, like Roman ruins. And there was just great food and culture. &

Learn More: Rebecca Cady was one of Risk & Insurance®‘s 2018 Risk All Stars. Read more about the awesome strides Cady’s made in her risk management program.

Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]

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]