To understand where risk management is going, we need to appreciate its past. Historically, risk identification/ management was instituted in the corporate world in the 1940 s as a quality control technique. In the 1970 s, the nation faced a medical malpractice crisis, with a dramatic rise in the number of malpractice claims being filed and given staggering jury awards. The large awards affected professional liability insurance markets. Faced with potential bankruptcy, insurers either withdrew from the market or demanded heightened accountability in reporting and managing risks from insureds. Healthcare providers responded by creating coverage options and initiating programs to identify and control professional liability risks. Risk management efforts focused on retrospective reviews of incidents, loss reduction, and claims management. Since efforts were directed toward narrowly-focused functions and retrospective reviews, the data gathered and the prevention proposed were often seen by management and staff as being reactive, stale and no longer relevant. Over the years, risk management has evolved in sophistication and relevance. Today, risk management efforts have expanded beyond investigation, prevention, and claims management. Risk management now tackles more than its traditional roles of looking at what went wrong, who did it, how it can be prevented from happening again, how can costs be controlled, how can defense best be managed, how can structured settlements be handled, and how can staff be educated. Like the body's fascia, risk management is now an integral part of a healthy organization s basic components. It protects and supports the board, management, leadership, staff, and every department, activity, committee, policy and procedural consideration, educational program, and strategic planning goal. The expanding role of risk management is largely due to a new understanding and perception among organization management as they assume a more proactive stance in their corporate governance roles. Boards and executive management increasingly realize and support the importance of the developing role of risk management in achieving the health system s mission, goals, and strategic initiatives. As they assume a more proactive stance in their corporate governance roles, boards that were once satisfied with a cursory glance at annual risk management reports are beginning to rely on regular reports throughout the year that include legal and regulatory updates, enterprise-wide risk efforts, and education. As management s appreciation of the value of risk management over the entire strata of their enterprise grows, there will be a trend, beginning with larger hospital systems, to appoint a Chief Risk Officer to develop, coordinate and supervise enterprise-wide proactive risk management activities. Meanwhile, risk management continues to meet traditional needs and goals while expanding its responsibilities and concomitant skills. New strategies and synergies include more collaboration, cooperation and transparency in an enterprise effort of managing risks throughout the organization. Risk management has initiated benchmarking and best practices in its efforts to re-frame its identity and relevancy in the ever-evolving health care industry. The future of risk management strategies will likely focus more on cross-disciplinary communication, both horizontally and vertically, within an organization. As a business decision and practice, progressive organizations will encourage risk management to expend more effort on looking for ways to better communicate what is known, being learned, and anticipated within the strata of the entire system. This new focus will not only increase transparency of risk-reduction/management information within an individual organization, but also act as a catalyst to promote a collaborative effort of transparency between healthcare providers nationwide. This type of national collaboration is needed to improve excellence in patient care delivery and quality practices. It will also enable providers to better understand the causes of process variations and to prioritize resources accordingly. For this collaboration to occur, tort reform to educate the public, curb frivolous claims, and cap damages is needed on a national scale. Meanwhile, steps are being taken by many risk managers to integrate and permeate the various layers of their organizations with risk management awareness and function. Risk management is beginning to promote and assist in fostering cross-training, and collaborative care and watchfulness among caregivers and leaders alike. Being your brother s keeper reduces unexpected events though skilled individual and team decision-making, allowing for immediate course-correction before a misadventure occurs. Management is beginning to ask for risk management input in assessing new clinical services or programs, particularly those that are high-risk. Performance improvement and risk management are now attempting to firmly hold hands, whereas in the past, they briefly touched fingertips lest one cross-contaminate the other with discoverability. The norm is now to include both of the directors of performance improvement and risk management on key committees in respective areas. Both disciplines are now learning methods to effectively use and communicate root cause analysis collaboratively. Both immediately respond to review and intervene in instances of near-misses as detected by staff or real-time computerized tracking capabilities that alert the caregiver of a pending variance before it occurs. Both disciplines also participate in collaborative gap analysis of issues and occurrences to determine changes that are needed for organizational health. For optimal organizational penetration of risk management strategies, an organization's silos, housing peer review, quality improvement, safety, patient relations, information management, corporate compliance, and risk management efforts, must be dismantled. Free-flowing communication and shared reporting forges maximum linkage and alignment among the areas where activities, processes, performance, information and initiatives affect patient care and satisfaction, quality, financial stability, community perception, and ultimate realization of strategic goals. For an organization to realize the full potential of a risk management program, it must decide to move forward proactively with a full-time focus on risk management. Risk managers who are spread too thinly in the organization can only look back and react. However, there is a whole new era of proactively managing risks that is possible when a board and its executive staff envision excellence throughout the enterprise. This article was reprinted with permission from Cath Lab Digest 2005;13:30.