(a) The purpose of this Part is to ensure that providers of mental health services develop and implement effective incident management programs in order to protect the health and safety of patients and enhance their quality of care. Incident management programs include the components of effective abuse protection; the classification of incidents; tracking and trending of incidents; and implementing effective actions to protect individuals served from harm.

(b) It is the expectation of the Office of Mental Health that providers of mental health services under its jurisdiction will afford their patients appropriate services in a caring and hospitable environment that is recovery-oriented and free from harm. In order to create this environment, providers must seek to eliminate, wherever possible, the occurrence of incidents, i.e., episodes of harm or potential harm. This Part thus requires providers to assure that any reportable incidents are reported and analyzed, and the appropriate corrective, remedial, or disciplinary action occurs, in accordance with applicable Federal or State law and regulations.

(c) Incident management programs must also incorporate principles of clinical risk management, which emphasize the improvement of systems and processes. Clinical risk management involves review of incident patterns and trends to identify the facts, circumstances, processes, systems, and areas of risk that may have contributed to such incidents in order to identify opportunities for performance improvement.