News & Perspectives

Human Services - Incident Management


State and local human services organizations have an obligation to ensure the safety of vulnerable individuals under their care. Unfortunately, insufficient oversight related to out-of-date policies or inadequate systems can leave this obligation unfulfilled.

Two federal reports issued in January 2018 highlight gaps in program oversight for vulnerable populations and the importance of effective incident management. The U.S. Department of Health and Human Services, Office of Inspector General[1] found that group home health and safety policies and procedures are often not followed, leaving beneficiaries at risk of serious harm. Additionally, the U.S. Government Accountability Office[2] indicated that improved federal oversight of the health and welfare of Medicaid beneficiaries receiving assisted living services is needed.

PCG has worked with several states to assess and improve their incident management processes and systems. Lessons learned from these experiences – which have been shared in APHSA’s Policy & Practice magazine [3] – provide important insights for states interested in taking proactive steps to improve. Some questions to consider:

  • Could business processes that support incident management be improved?

  • Are there IT systems upgrades that can improve information sharing?

  • Do existing incident management systems contain standardized, automated protocols for reporting and tracking incidents?

  • Is a multi-agency unified incident management system feasible and/or desirable?

  • Do you lack an incident management system and if yes, have you considered solutions?

  • Could the consistency and clarity of your existing incident management regulations, policies, and procedures be improved?

Contact us today to learn more about how our incident management consulting services can help you.



[1] U.S. Department of Health and Human Services, Office of Inspector General. (January 2018). Ensuring Beneficiary Health and Safety in Group Homes Through State Implementation of Comprehensive Compliance Oversight.

[2] U.S. Government Accountability Office. (January 2018). GAO-18-179 Medicaid Assisted Living Services: Improved Federal Oversight of Beneficiary Health and Welfare is Needed.

[3] Salisbury, S., & Fawcett, A. (August 2017). Promising Practices for Incident Management: How We Can Keep Vulnerable Citizens Safer. Policy & Practice, 9-12.