CLINICAL INTELLIGENCE IN HEALTHCARE RISK COMPLIANCE AND INSURANCE INVESTIGATIONS: A Daily Reference for Hospital Risk, Serious Incident Investigations, Compliance, Insurance Claims, and SIU Decisions
Language: English
Published by Lexcura Summit, 2026
- Softcover
- New
Seller: California Books, Miami, FL, U.S.A.California Books
AbeBooks seller since October 27, 2023
Condition: New
£ 43.21
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- Title
- CLINICAL INTELLIGENCE IN HEALTHCARE RISK COMPLIANCE AND INSURANCE INVESTIGATIONS: A Daily Reference for Hospital Risk, Serious Incident Investigations, Compliance, Insurance Claims, and SIU Decisions
- Author
- Carroll, Michelle
- Publisher
- Lexcura Summit
- Publication year
- 2026
- Condition
- New
- Binding
- Soft cover
- Language
- English
- ISBN 13
- 9798952094444
When a serious hospital event occurs, the same facts immediately enter several decision systems. Hospital leaders must determine what happened and what needs to change. Risk professionals assess patient safety and institutional exposure. Compliance teams examine regulatory obligations and program effectiveness. Insurers evaluate liability, damages, coverage, and reserves. Special Investigations Units decide whether an anomaly justifies further investigation. Counsel must establish what the evidence supports—and where the limits of that evidence lie.
Clinical Intelligence in Healthcare Risk, Compliance, and Insurance Investigations provides a disciplined method for conducting those inquiries without allowing the assumptions of one function to become the conclusions of another.
Built around the seven pillars of the Lexcura Clinical Intelligence Model™, the book shows readers how to:
• Test the integrity, completeness, and reliability of the record
• Establish the patient’s clinical baseline before evaluating later events
• Analyse imaging, laboratory findings, and other objective evidence
• Reconstruct the clinical and operational timeline
• Evaluate standards of care and reasonable alternative actions
• Apply regulatory and compliance requirements to the supported facts
• Map causation without overstating foreseeability, preventability, or intent
The book also examines the four different clocks that begin running after a hospital event: the clinical clock, the evidentiary clock, the reporting clock, and the insurance-claim clock. Understanding how these clocks interact is essential when determining whether care was appropriate, whether reporting duties were met, whether evidence was preserved, and whether an investigation should be expanded.
Three complex worked cases take the reader through every pillar of the model. Each case demonstrates what the reviewer should examine, which questions should be asked, what conclusions can reasonably be drawn, and which issues must remain unresolved until further evidence is obtained.
Practical decision tools, investigation pathways, review checklists, escalation frameworks, and cross-functional outputs make this a working reference rather than a book that is read once and set aside.
Written for hospital risk leaders, compliance professionals, serious-incident investigators, insurance claims teams, SIU specialists, healthcare attorneys, clinical experts, and executive leadership, this book provides a common analytical foundation for decisions that must be clinically grounded, operationally useful, and capable of withstanding scrutiny.
"Synopsis" may belong to another edition of this title.
California Books
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