The Value of Being Proactive in Health Care Risk Management | Kelley Simoneau Woodfin

Pursuing a medical or nursing career almost certainly has a profound impact on a person’s life, including but not limited to the length of time and the cost of education. Nurse and Risk Management Consultant Kelley Simoneau Woodfin R.N. B.S., DFASHRM, CPHRM, however, emphasizes how gratifying such a career can be even with factors currently encumbering the health care industry.

Kelley Simoneau Woodfin CORE Risk Services

With a robust sense of advocacy and strong nursing and administrative skills, Kelley Simoneau Woodfin R. N. B.S., DFASHRM, CPHRM, has had extensive experience in practically all levels of the industry. Currently, she owns and operates a risk management consulting business, CORE Risk Services, Inc. As principal consultant, she works with clients to develop and implement their enterprise-wide Risk Management Programs, helping them learn strategies for preventing and resolving conflicts that arise during the provision of health care services.

Woodfin’s unwavering commitment to nursing began at a young age. As a young toddler, she contracted polio during a pediatrician visit, accompanied by her young father, a U.S. Naval Officer. Highly contagious and debilitating, the polio virus attacks the central nervous system, not infrequently resulting in paralysis and death. Both Woodfin and her father contracted the virus during that visit. She survived it, but her father did not.

“The Naval doctors told my mom it was not likely I would survive the infection but that if I did, I would be in an iron lung the rest of my life. My mom implored them to transfer me to the local Catholic hospital so that I could receive the Sister Kenny treatment. They agreed to do so because they thought I was going to die anyway, so I imagine they simply thought, ‘what could be the harm?’”

Readers might be familiar with the Sister Kenny polio treatment. Sister Kenny was an Australian nurse. She theorized that the virus could be killed by heat, and her treatment was to keep a patient’s body temperature at or above 104 degrees over a sustained period of time, halting the progression of viral activity. Woodfin’s body temperature was kept elevated by being wrapped in hot, wet sheets for a period of 72 hours. Imagine, if you will, being a very sick and tiny 18-month-old child going through this process.

At the time, the medical community was skeptical of this unconventional method, but it proved effective for Woodfin and many other surviving polio victims today who are alive and active because of it. Sister Kenny’s protocol for muscle rehabilitation later became the foundation for modern physical therapy. Sister Kenny is lauded today as one of the most influential nurses of her generation, unafraid to challenge conventional medicine for the welfare of patients.

Having experienced attentive and caring nurses during this illness and recovery process, Woodfin became determined at a young age to pursue a career in the nursing profession.

“My nurses were nuns during my period of isolation. Each nun wore a habit that stuck out from their face. I clearly remember poking my little head inside close to their face and laughing as only a toddler can laugh. I remember their big smiles as my face came close to theirs. They all not only allowed me to do this, but they even encouraged me to do it although I was ostensibly still contagious.”

Woodfin began her nursing studies at the Los Angeles County Hospital School of Nursing at the tender age of 16 1/2. She was assigned a patient to care for on day one of her training, and he spoke only German! She loved working with patients and learning nursing theory for the three years of training. At the completion of the program, she took the national nursing board exam and earned her California nursing license. While awaiting her license, Woodfin worked as the only R.N. in the hospital’s pediatric intensive care unit (ICU). Woodfin believes that this assignment was formative for her as, being the only nurse in this high-pressure environment, she learned how to be situationally aware and to use critical thinking to care for these critically ill children.

Her career in emergency services began when, after receiving her nursing license, she moved to another California county to work in the County Hospital in the Emergency Department. Two years later, she moved back to the beach city where she grew up and was hired to work in the local hospital Emergency Department. Spending her requisite two years on the night shift, she later worked evenings and days. With experience on all shifts, she was promoted to shift supervisor, Paramedic Liaison Nurse, ED Nursing Director and finally, to a newly created position of ED Clinical Nurse Specialist.

Rapid decision-making was an Adrenalin escalator for her. The unending presentations of different health conditions helped her understand and be quick to establish what was needed for each patient. She poured her heart into her job with relish and volunteered for many projects, from the development of the first rape treatment center to the development and implementation of the county’s first paramedic base station.

As the ED Paramedic Liaison Nurse, she was responsible for teaching the ED nurses and paramedics how to work together via radio communication. She also had “too numerous to count ride-along experiences” with paramedics, during which she was the senior expert on-site and could provide orders to the paramedics for patient management. She also became one of the first five emergency nurses to earn the designation of Mobile Intensive Care Nurse in the state of California. During this season, she was also hired to serve as instructor for the first college EMT-I training program in the state by the local community college. She is proud of the work the nurses did in that ED.

“Because we had a typical 24-hour day average of 300 patients, primarily on the day and evening shifts, we nurses became out of necessity proactive with nursing diagnosis and clinical interventions from triaging patients to initiating interventions for those whose condition required, such as starting oxygen and IVs, performing electrocardiograms and ordering limb films and labs. With only one physician on duty for a 12-hour period, it was essential that we function as active team members. As a result of our actions, the ED physician was able to move through the caseload quickly and efficiently. The docs trusted us, and we trusted them, and the teamwork and communication were exceptional.”

Woodfin says, “One of the hallmarks of my time in that E.D. was that I was willing to teach, mentor, and manage nurses in the ED, and I was known to volunteer for a variety of department projects. Each time I participated in or managed these projects, my knowledge and skills in emergency nursing were enhanced.”

She continues to urge nurses to get engaged in projects, believing that they are great motivation and offer good learning experiences that will help them in their careers.

During her eight-year tenure at this ED, Woodfin implemented many positive changes. She held critical incident stress de-briefing when high-acute cases were managed or a resuscitation failed. And she was one of the, if not the only, ED managers at the time to allow parents to stay with their child in the ED during treatment, including critical procedures such as resuscitation.

Kelley Simoneau Woodfin CORE Risk Services

“I always had a parent-support person in the room while a pediatric resuscitation was happening. In many cases, this was the hospital social worker, but it could also be a staff nurse. I understood that having no understanding of what was or had been done for their child made them feel helpless, increased their confusion about what they could have or should have done for the child and struggle with their grief if the child died.”

Kelley Simoneau Woodfin CORE Risk Services

Woodfin was subsequently recruited to help start up the ED at a large two-hospital merger in West Hollywood/Beverly Hills, where she served for three years as ED Clinical Instructor and, for a one-year period at the same time, she developed and implemented the Paramedic Base Station and served as Paramedic Liaison Nurse. As the clinical instructor, she provided emergency nursing education, orientation for all new hires, and monthly nursing and paramedic education. During this time, she was also a California disaster service worker and the only licensed R.N. on the California Governor’s Earthquake Task Force, for which she developed the state emergency triage plan.

She was recruited from this position by Life Flight Southern California and served as its Flight Coordinator/Assistant Administrator. Life Flight was a helicopter transport service operated by two large medical centers in the southern California beach cities area. Woodfin provided administrative oversight, scheduling, dispatch management, and flight nurse education and developed the service’s fixed-wing transport program, one of the first in the nation. She also took 24-hour shifts and flew on runs with the pilot.

Among her many career accomplishments, Woodfin earned certifications as a critical care nurse (CCRN) and as an emergency nurse (CEN) and served in the California Emergency Nurses chapter as president. She was nominated by the organization’s Board to serve a five-year term as the only registered nurse on the Los Angeles County Commission/Committee for Emergency Services, a group instrumental in guiding Los Angeles leaders to make wise programmatic decisions that had an impact on both field services and emergency departments.

Following these activities, Woodfin went to work for a private company, serving as an emergency nurse consultant. In this role, she traveled extensively throughout the Midwest and east coast to negotiate emergency physician contracts, provide nursing consultation to emergency department administrators, and deliver ED nursing education courses.

Later, while working for one of the two largest HMOs in the nation, Woodfin served as Associate Director of Nursing for the staff model clinics and was subsequently called to serve as Staff Model Risk Manager. Following her promotion to the position of Director of Risk Management for the company’s private network covering 900,000 lives, she worked closely with the company’s legal counsel on pre-litigated and litigated claims and provided advice and direction for all departments when potentially compensable events, escalated issues, and legal claims occurred.

Subsequently moving to serve as Director of Risk Management for a smaller HMO in Los Angeles, Woodfin earned a Bachelor of Science in business administration. After several years at this company, she was recruited and hired by Aon Corporation Risk Consulting Services Inc. to serve as an outsourced Corporate Risk Manager to a group of long-term care companies that had started a captive insurance company which required each participant to have a risk management program. A year later, these companies all agreed that one would hire her to serve the collective group as Vice President of Risk Management Consulting Services. Working in that capacity, she built a client base of 12 other California long-term care companies for whom she provided risk management services.

Woodfin launched her own risk management business, CORE Risk Services, Inc., in 2009. As President and primary consultant, she works with senior executives, administrators, physicians, managers, point-of-service staff, attorneys, claims managers and insurers to implement, review and strengthen loss prevention and control programs. She has a proven track record of achieving positive outcomes in the management of escalated events, potentially compensable events, and alternative dispute resolutions, saving her clients a collective amount of over $1,000,000. Her team is comprised of a project coordinator, a board-certified geriatrician, independent contractors, and corporate counsel.

“The risk that an adverse event will happen is an equation written as: risk = potential severity of an adverse event multiplied by the likelihood that a poor outcome or adverse event will occur, or R = S x L.”

She notes that “the ability to make this determination is not generally within the expertise of health care providers” and she comes alongside each one to help them learn how to identify and manage potential and actual risks.

“With a focus on achieving consistently positive outcomes over time, which is the definition of ‘high reliability,’ I help clients build and effectively manage their loss prevention and control program. I teach employees how and why to report incidents, how to de-escalate angry patients or families, how to establish realistic expectations of patients, and risk management strategies and techniques that can be used to preserve financial and human resources after an adverse event. To accomplish this, I customize administrative initiatives to achieve this goal.”

Woodfin acknowledges that establishing the components of an effective loss prevention and control program can be difficult and expensive for solo practitioners, small clinics and hospitals when they do not have risk management resources to help them. She adds, “other supporting elements of a robust risk management program are the incorporation of continuous quality improvement activities, achievement of compliance with established policies and procedures and law, provision of loss prevention education, and performing effective legal claim management.”

Woodfin has always thought of herself as an advocate for patients, colleagues, and clients.

“I believe it is vital to help my clients prevent small or repetitive issues from becoming high-cost litigation and to prevent the same or similar situations from occurring in the future.”

Knowing that the recent pandemic shed light on cracks in our current health care system, Woodfin agrees that it exacerbated an existing shortage of nurses and states that “Unfortunately, many nurses today feel underappreciated and underpaid for the level of responsibility that they have.”

She believes that, partly due to government involvement in health care and partly due to the litigious health care environment, there is overbroad involvement of local, state and federal governments in health care and government interference with physician decision-making about patient care and treatment.

“In my humble opinion, this is tantamount to government ‘practice of medicine’, which all providers will acknowledge is antithetical to the physician-patient relationship.”

Woodfin understands that different types of health care have different degrees and types of risk.

“A risk assessment of a long-term care facility will differ from that of a home health agency. I will never act like a punitive government representative. I am there to assist and support my clients to develop an effective Risk Management Program.”

Dedicated to the practice of risk management, Woodfin is a member of both the local and national chapters of the American Society for Health Care Risk Management and has served a three-year commitment on the Board and then as president of the local chapter, which recognized her with their Lifetime Achievement in Risk Management Award. Over her career, Woodfin has provided more than 500 lectures for health care professionals across the nation and in Canada. She is also extensively published in professional journals and textbooks and co-wrote a textbook entitled “Emergency Preparedness for Healthcare Facilities” for Aspen Publishers.

Kelley Simoneau Woodfin CORE Risk Services