Managing Risk and Defenses to Lawsuits in Quality Improvement

1. Chapter 4 Risky Business: Managing Risk andDefenses to Lawsuits

2. Quality Improvement • Measures an office takes to help guarantee a high quality of care • Risk manager or office manager usually responsible Learning Objective 4.1

3. Quality Improvement (cont’d) • Examples of duties • Monitor continuing education among staff • Monitor lab equipment • Ensure drugs and clinical supplies are not outdated Learning Objective 4.1

4. Managing Risk • What is risk management? • Following practices designed to reduce risk of injury • What does it involve? • Identifying possible dangers • Working to prevent or eliminate them Learning Objective 4.2

5. Managing Risk (cont’d) • Basic parts of a risk management plan • Written job descriptions • Procedure manual • Policies manual Learning Objective 4.2

6. Managing Risk (cont’d) • Policies manual should cover: • Patient privacy • Clinical treatment • Patient communications • Documentation Learning Objective 4.2

7. Managing Risk (cont’d) • Practicing defensive medicine • Order more lab tests, consultations, referrals • Refuse to accept new patients • Refuse to testify against colleagues Learning Objective 4.2

8. Managing Risk (cont’d) • Premises safety • Pay attention to your work area • Look for waiting room hazards Learning Objective 4.2

9. Managing Risk (cont’d) • Product risks • Use products correctly • Warn patients of side effects • Instruct patients about proper use Learning Objective 4.2

10. Burden of Knowledge • Responsibility to speak out if aware of wrongdoing • Malpractice • If you don’t speak out, you violate professional ethics and duty of care Learning Objective 4.3

11. Malpractice Prevention • The four Cs • Caring • Communication • Charting • Competence Learning Objective 4.4

12. Caring • Show sincere concern for patient • Communicate understanding, empathy, and compassion • Understanding • Aware of patient’s emotions • Recognize patient’s point of view • Empathy • Sharing the patient’s feelings Learning Objective 4.4

13. Caring (cont’d) • Compassion • Desire to help others • Ease patient’s “pain” • Final step in caring • Do not make promises about outcomes! Learning Objective 4.4

14. Caring (cont’d) • Avoid inappropriate behavior in the office • Loud laughing • Horseplay • Displays of secrecy, extreme excitement • Don’t criticize another worker or a physician in front of patients Learning Objective 4.4

15. Communication • Helps you gain patient’s trust and respect • Patients less likely to sue if staff viewed as friendly and helpful • Communicate caring attitude Learning Objective 4.4, 4.5

16. Communication (cont’d) • Talking to patients • Use good listening skills • Don’t make patient feel hurried or “brushed off” • Make eye contact • Use appropriate touch Learning Objective 4.4, 4.5

17. Charting • Medical records often used as evidence in lawsuits • Need to be thorough and accurate • Records should clearly show: • Procedures and treatments patient received, when done • All test results • Medication prescriptions Learning Objective 4.4

18. Charting (cont’d) • What to document • Patient contacts • Missed appointments • Referrals • Consent and refusal • Telephone conversations Learning Objective 4.4

19. Competence • Know and follow requirements of good medical practice • Provide high standard of care • Keep up with changes in office and practice of medicine Learning Objective 4.4, 4.6

20. Professional Competence • Stay up-to-date • Read journals • Interact with medical assistants • Obtain or maintain credentials • Take advantage of staff training Learning Objective 4.4, 4.6

21. Workplace Competence • Have a good knowledge of your field • Work within your scope of practice Learning Objective 4.4, 4.6

22. Why Do People Sue? • Medical reasons • Relates directly to treatment • Personal reasons • How patient treated by staff and physician Learning Objective 4.5

23. Why Do People Sue? (cont’d) • Other medical factors • Poor outcomes • Unrealistic expectations • Poor quality of care • Attitude of staff in all these situations can influence patient’s decision to file complaint Learning Objective 4.5

24. Poor Outcomes • Medicine not an exact science • Signs and symptoms could point to several diseases • Sometimes results not what expected • Do not tell patient everything will be fine – can sue for breach of contract! Learning Objective 4.5

25. Unrealistic Expectations • Advances in technology cause some patients to expect more than is medically possible • Do not tell patients they are going to be fine! Learning Objective 4.5

26. Poor Quality of Care • Provider does not meet duty or standard of care • Attitudes and behaviors of staff can cause patient to perceive this is the case Learning Objective 4.5

27. Understanding Patient’s Needs • Patients want to be seen as individuals • More likely to sue if feel ignored or mistreated • Long delays to see a physician add to frustration • Long wait for scheduled appointment • Long wait in waiting room • Overbooking • Waiting too long for a return call from the office Learning Objective 4.5

28. Have a Responsible Attitude • Practice medicine in a way that prevents lawsuits • Behavior of medical staff is crucial • Staff must work to reduce patient anxiety and frustration • Communication is key! Learning Objective 4.5

29. Behaviors That Reduce Risk • Act within scope of practice • Keep equipment in safe and working order • Keep floors clean and clear Learning Objective 4.5

30. Behaviors That Reduce Risk (cont’d) • Open doors carefully • Dispose of biohazardous waste in proper containers • Document all patient contact Learning Objective 4.5

31. Behaviors That Reduce Risk (cont’d) • Never promise a recovery or cure • Maintain confidentiality of patient information • Acknowledge long waits • Treat patients with courtesy and respect Learning Objective 4.5

32. Defenses Against Lawsuits • Assertions of innocence • Deny wrongdoing • Technical defenses • Depend on legal points and principles, not evidence • Affirmative defenses • Rely on evidence that harm not fault of provider Learning Objective 4.7

33. Technical Defenses • Statute of limitations • Release of tortfeasor • Res judicata • Borrowed servant doctrine Learning Objective 4.7

34. Statute of Limitations • States limit length of time plaintiff has to bring charges • Time limit depends on 3 factors • State • Civil vs. criminal law • Type of wrongdoing Learning Objective 4.7

35. Release of Tortfeasor • Tortfeasor is someone who commits a tort • Legal doctrine • Often applied when more than one tortfeasor Learning Objective 4.7

36. Res judicata • Legal doctrine • Claim cannot be retried once lawsuit has been settled Learning Objective 4.7

37. Borrowed Servant Doctrine • Legal principle • Employer not liable if employee is working for someone else Learning Objective 4.7

38. Affirmative Defenses • Contributory negligence • Comparative negligence • Assumption of risk • Emergency Learning Objective 4.7

39. Contributory Negligence • Claim patient’s own actions caused or contributed to injury • If proved, patient cannot collect damages Learning Objective 4.7

40. Comparative Negligence • Patient partly responsible for injury • Patient can still recover partial damages Learning Objective 4.7

41. Assumption of Risk • Claim patient knew risks • Provider must prove: • Patient aware of risk of bad outcomes • Bad outcomes caused patient’s injury Learning Objective 4.7

42. Emergency • Provider claims care given in emergency situation • Can’t be held to same high standard of care as non-emergency Learning Objective 4.7

43. Emergency (cont’d) • Provider must prove: • True emergency existed • Emergency not caused by provider’s actions • Standard of care was appropriate Learning Objective 4.7

44. Malpractice Insurance • Liability and malpractice insurance helps medical providers manage risk • Covers employees • Pays damages to patient if provider successfully sued • May pay provider’s attorney fees Learning Objective 4.8

45. Malpractice Insurance (cont’d) • Why carry your own insurance? • Conflicting goals of employer and medical assistant in settling lawsuit • Employer may want to settle out of court • Insurance cheaper than hiring lawyer and paying damages Learning Objective 4.8