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Risk Management Chapter Ten. Understand the goals of an effective risk management program. Be aware of loss prevention strategies used to improve patient care and reduce exposure to malpractice claims.
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Risk Management Chapter Ten
Understand the goals of an effective risk management program. Be aware of loss prevention strategies used to improve patient care and reduce exposure to malpractice claims. Appreciate the appropriate manner in which to explain untoward events to patients and families. Understand ways of maintaining good communication with patients and families. OBJECTIVES
Obstetrics Emergency medicine General surgery Surgical subspecialties Radiology Specialties Having DifficultyObtaining Affordable Coverage
Malpractice Climate The Remaining States Are Showing Problem Signs
“Professional misconduct or unreasonable lack of skill in the provision of medical care.” Definition of Malpractice
In civil legal actions, attempts to make the victim as “whole” as possible generally manifest as awards of money damages sufficient to return the victim to the “status quo ante” (state in which they were before the injury). Outcomes Favorable To Plaintiff
Use of cutting-edge treatments Advent of managed care Reports in the media Causes Of Increasing Settlements
Many physicians, faced with increasingly hefty insurance premiums or, in some states, an inability to obtain coverage, have been driven out of practice or have had to limit their practices. Effects of the Healthcare System
Risk management is defined as “identifying, evaluating, and minimizing exposure to the risk of liability that is inherent in the provisions of health care services.” Definition of Risk Management
Insure that practitioners are competent and patients are safe. Minimize the damage to physicians and practices from marginal or unwarranted lawsuits. Goals of Risk Management
Legislated capitation on verdict and settlement payouts Combining capitation of noneconomic damages, that is, pain and suffering, with reforms to eliminate joint and several liability and shorten statutes of limitation. Climate for Tort Reform
Placing a flat percentage maximum on fees Imposing a sliding scale for fee payment. Tort Reform Proposals
The California Medical Injury Compensation Reform Act (MICRA) of 1974 serves as a gold standard for many proponents of national tort reform in their efforts to lobby Congress. California’s reforms specifically put caps on noneconomic damages. MICRA
Diagnosis and Screening Follow-up Patient identification Over sedation of patients Complex technology Inadequate training of personnel Areas of Risk in ACOs
Patients who have sued before, have a pending lawsuit, or simply talk as if they have a contentious nature People who are unhappy, often for reasons unrelated to their health Patients Likely to Sue
People who do not understand their diagnosis, treatment, or instructions for self-care Family members, acquaintances, friends, colleagues, or people who are busy and do not want to take the time for consultations or detailed instructions Patients Likely to Sue
Communication skills Knowledge of their life circumstances Knowledge of their whole-person situation Knowledge of medical history Patients Unfavorable Ratings of Their Primary Physician Include:
“Any perceived or actual negative event related to patient care, or any other medical or administrative occurrence that deviates from the normal course of patient interaction or treatment.” Definition of an Incident
Errors in diagnosis Medical misadventure Improper procedures performance Failure to supervise or monitor care Medication errors Procedures performed when not indicated or when contraindicated Failure or delay in referral or consultation Most Frequent Allegations of Wrongdoing
The duty to disclose the risks of treatment The duty of confidentiality regarding information about the patient The duty of providing “reasonable care” in the supervision of resident physicians Professional Legal Duties
Explaining untoward events Listening Providing comprehensive informed consent Speaking with patients at a level they can understand Allowing patients to partner with the practitioner Areas of Importance
Keep a steady flow of communication with the patient and the patient’s family. Calling just to follow up, with no particular agenda, helps inspire a patient’s trust in a provider. Identify potentially high-risk patients, but be careful to not stereotype patients. Be aware of cultural diversity. Communication
Develop fail-safe systems in every area of the practice. Use more formal tracking systems for patient satisfaction. Do not review cases outside of your specialty. Avoid disagreements among healthcare members. Use of Systems
Notify the insurance company Solicit expert reviews Collect depositions Decide whether to settle or defend Prepare for trial Steps in Litigation Management
This legislation called for the creation of the National Practitioner Data Bank (NPDB), which serves as a central clearinghouse for information about the competence and conduct of healthcare practitioner. Public Law 99-660, the Healthcare Quality Improvement Act of 1986.
