The medical malpractice TPA: Taking it to the next level

Risk managers whose organizations self‐insure their medical professional liabilities often find themselves dealing with their institution's third‐party administrator (TPA), the independent entity that manages claims against the organization and its employees. By understanding better the purpose and operations of a TPA, risk managers can enhance their organizations’ litigation outcomes while adding new tools to improve patient safety and quality of care. Viewing the TPA simply as an expense item to be reduced to its lowest possible level deprives the organization of a valuable resource in the form of high‐quality data on the drivers of professional liability losses. This article identifies the qualities found in an exceptional medical malpractice TPA and suggests ways to create an effective partnership that will reduce the total cost of claims while supporting the risk manager's mission.     

The top ten malpractice claims [and how to minimize them

Here are the 10 most common causes of malpractice lawsuits against hospitals and a range of potential solutions suggested by risk managers and patient safety experts.     

Decreasing intrapartum malpractice: Targeting the most injurious neonatal adverse events

Medical malpractice expenditures are mainly due to the occurrence of preventable harm with some of the highest liability rates in obstetrics. Establishing delivery system models which decrease preventable harm and malpractice risk have had varied results over the last decade. We conducted a case study of a risk reduction labor and delivery model at 5 demonstration sites. The model included standardized protocols for the most injurious events, training teams in labor and delivery emergencies, rapid reporting with cause analysis for all unplanned events, and disclosing unexpected occurrences to patients using coordinated communication and documentation. Each of the model's components required buy in from the hospital's clinical and administrative leadership, and it also required collaboration, training, and continual feedback to labor and delivery nurses, doctors, midwives, and risk managers. The case study examined the key elements in the development of the model based on interviews of all team members and document review. We also completed data analysis pre and post implementation of the new model to assess the impact on event reporting and high liability occurrence rates. After 27 months post implementation, reporting of unintended events increased significantly (43 vs 84 per 1000 births, p < .01) while high‐risk malpractice events decreased significantly (14 vs 7 per 1000 births, p < .01). This decrease enabled money allotted for malpractice claims to be reallocated for the implementation of the new model at 42 additional labor and delivery sites. Due to these results, this multilevel integrated model showed promise.     

新医改背景下医院成本核算的对策

随着新医改方案的公布,提出按病种付费等方式的改革,这对医院来说提出了新的挑战。原有的成本核算模式已经不能满足需求。本文针对医院现有成本核算的弊端,提出了改进成本核算模式的对策,以适应新医改的变化,并对医院管理者提供管理建议。     

谈军队医院加强医疗风险管理

医疗安全与医院的生存发展息息相关,医疗风险、医疗差错和医疗纠纷长期困扰医院管理者和医务人员,加强医疗风险的认识和应对措施非常重要。强化医疗风险管理的意识,提高风险防范能力,建立完善安全管理、监督检查和持续改进机制,加强重点专业、医院感染和病理质量管理,是有效规避医疗风险,防范医疗事故和减少医疗纠纷的治本之策。     

Reducing physician vulnerability to professional liability claims: what practices make a difference?

Physicians--both "good" and "bad"--may find themselves targeted in medical malpractice lawsuits for reasons not necessarily related to recognized acts of commission or omission. As a result, taking appropriate steps to reduce their vulnerability to claims that may eventually be brought against them makes good sense from a risk management perspective. This article looks at the frequency, severity, reasons for, and "misadventures" associated with one physician-owned medical malpractice company's professional liability claims and offers selected practice management strategies that can help enhance physicians' defensibility in the event they are sued.     

Existing and potential use of models in the control and prevention of disease emergencies affecting aquatic animals

Models are tools that aid managers to make decisions in a transparent manner. Models are implicitly used to devise any management plan, but scientific modelling makes the approach explicit and transparent. Simple models are often more useful than complex models, especially when time and data are short--as in many emergency situations. Four areas in which modelling can help aquatic animal health managers to control or prevent disease emergencies are identified, and their application reviewed. These areas are: models of factors behind disease outbreaks; models for the design of efficient surveillance; models of disease spread (subdivided into Susceptible-Infected-Removed [SIR] models, coupled hydrodynamic-particle transport models and network models); and models to evaluate the consequences of disease outbreaks. Import risk analysis and SIR modelling have been applied fairly extensively; risk-based surveillance is likely to be a driver for increased modelling effort in the near future.     

Implementing an error disclosure coaching model: A multicenter case study

National guidelines call for health care organizations to provide around‐the‐clock coaching for medical error disclosure. However, frontline clinicians may not always seek risk managers for coaching. As part of a demonstration project designed to improve patient safety and reduce malpractice liability, we trained multidisciplinary disclosure coaches at 8 health care organizations in Washington State. The training was highly rated by participants, although not all emerged confident in their coaching skill. This multisite intervention can serve as a model for other organizations looking to enhance existing disclosure capabilities. Success likely requires cultural change and repeated practice opportunities for coaches.     

Harnessing the power of medical malpractice data to improve patient care

Intelligence gleaned from medical malpractice cases helps health care institutions analyze their litigation practices, trend financial outcomes, and even identify clinical services needing attention. But when examined more deeply, medical malpractice data can also be a powerful patient safety tool by revealing clinical patterns that contribute to medical errors and by enabling leadership to more accurately plan investments in patient safety and risk management. This case study describes how one organization, UMass Memorial Health Care in Worcester, Massachusetts, harnesses its deeply coded medical malpractice data and benchmarks its performance against national peers to catalyze clinical improvements. This strategy has proven successful in yielding positive change in such areas as emergency department ultrasound coverage, obstetrics communication, and airway management training. UMass Memorial's ability to embed claims data use into its culture and to share learning across clinical services offers lessons for health care organizations of any size.     

A needs assessment investigation of continuing medical education in risk management

Training of physicians in risk management has become an important task for continuing medical education (CME) directors, particularly in states where risk management education is required for licensure. Physicians in Florida who completed an introductory program in risk management were surveyed to determine future topics for risk management education. Physicians identified desired topics using a five-point Likert-type scaling (5 = high priority; 1 = low priority) and rated 55 topics within 10 major subject areas. The means, standard deviations, and rank order of topics within the subject areas are reported. Multivariate analysis of variance (MANOVA) revealed no significant differences between surgeons and non-surgeons with respect to the subject areas. A significant difference, however, was shown, between academic physicians and non-academic (private practice) physicians; non-academic physicians gave significantly higher scores to six subject areas: malpractice, medical records, acts or omissions constituting negligence, negligence/malpractice actions, defenses, and risk management programs. The results suggest that it is not necessary to plan separate risk management education programs for physicians according to their specialty; one should note, however, the higher priorities given by non-academic physicians and consider these differences when planning advanced risk management programs.     

对《医疗事故处理条例》的几点认识--学习《医疗事故处理条例》的一点体会

国务院颁布的《医疗事故处理条例》（以下简称《条例》）在吸收、总结原《医疗事故处理办法》（以下简称《办法》）实施十几年以来正反两方面经验教训的基础上，对《办法》作了许多重大的修改：《条例》扩大了医疗事故的主体与范围，提出了防范医疗事故的一些重要措施，授权医学会独立担纲医疗事故技术鉴定工作，赋予了患者更多的权利，规定医疗事故民事责任争议可以“私了”，制定了更为规范的医疗事故的赔偿制度等。《条例》作出的这些新规定必将使医疗事故得以更加科学、客观、公正、公平、合理的解决。认真学习、把握《条例》的这些新规定，很好地透视《条例》的立法宗旨与原则，必将极大地提高学习、宣传《条例》的主动性与积极性，更好地推进《条例》的贯彻执行工作。     

对《医疗事故处理条例》的几点认识——学习《医疗事故处理条例》的一点体会

国务院颁布的《医疗事故处理条例》(以下简称《条例》)在吸收、总结原《医疗事故处理办法》(以下简称《办法》)实施十几年以来正反两方面经验教训的基础上 ,对《办法》作了许多重大的修改 :《条例》扩大了医疗事故的主体与范围 ,提出了防范医疗事故的一些重要措施 ,授权医学会独立担纲医疗事故技术鉴定工作 ,赋予了患者更多的权利 ,规定医疗事故民事责任争议可以“私了” ,制定了更为规范的医疗事故的赔偿制度等。《条例》作出的这些新规定必将使医疗事故得以更加科学、客观、公正、公平、合理地解决。认真学习、把握《条例》的这些新规定 ,很好地透视《条例》的立法宗旨与原则 ,必将极大地提高学习、宣传《条例》的主动性与积极性 ,更好地推进《条例》的贯彻执行工作。     

Do health care managers know the comparative quality of their care?

Compared with other industries, health care is a high-risk industry. In this study, two national data sets on patient claims and a survey of improvement efforts in Swedish health care were used to investigate the linkage between how health care managers perceive their performance regarding adverse medical events and their performance as reflected in patient malpractice claims rates. The departments' focus on patient safety issues in their improvement efforts was also evaluated. Our results show that Swedish health care department managers underestimate their departments' frequency of adverse medical events relative to that of similar units. Also, there is no correlation between the managers' perception of adverse medical events and their actual frequency of patient malpractice claims. More research is needed on the use of patient-generated malpractice claims and claims rates to promote a higher awareness of the magnitude of the safety problems in health care.     

National survey: Risk managers' attitudes and experiences regarding patient safety and error disclosure

Risk managers can play a vital role in promoting transparency in health care and enhancing patient safety. However, little is known about risk managers' patient safety attitudes and experiences. Therefore, the authors surveyed members of the American Society for Healthcare Risk Management, the largest organization of health care risk managers in the country. These risk managers identified important areas for improvement in the reporting and disclosure of medical errors.     

Solo versus group practice in the medical profession: The influence of malpractice risk

While Partnerships are a significant form of business organization in many sectors of the economy, relatively little is known about the incentives which lead to their formation. This paper explores the formation of partnerships among office based physicians when facing some risk of malpractice litigation. Theoretical results indicate that malpractice exposure can increase the incentives to shirk within a partnership, and so exert a significant influence on the decision to form a partnership. Empirical results find that malpractice risk has the expected negative effect on some partnership formation.     

How a successful litigator decides whether or not to sue you

This article aims to help physicians and other healthcare providers understand what prompts plaintiff lawyers to take on medical malpractice cases and to name the healthcare provider as a defendant in the suit. The article provides strategies for reducing the possibility of being named in a suit as well as for creating appropriate, favorable evidence that can be used for the healthcare provider if he or she is named in a suit. By understanding the "pluses" that cause a lawyer to sue, the risk of being sued can be decreased.     

An assessment tool for developing healthcare managerial skills and roles

This article is based on a study to identify, and by doing so help develop, the skills and roles of senior-level healthcare managers related to the needs of the current healthcare environment. To classify these roles and skills, a qualitative study was conducted to examine the literature on forces in the healthcare environment and their impact on managers. Ten senior managers were interviewed, revealing six roles as the most crucial to their positions along with the skills necessary to perform those roles. A pilot study was conducted with these senior managers to produce a final assessment tool. This assessment tool helps managers to identify strengths and weaknesses, develop in deficient areas, and promote competence in all areas as demanded by the market and organization. This tool can be used by organizations in the recruitment process and in the training process.     

Discovering gold mines in HRM

Two of my favorite tasks as a risk management professional are to mentor new risk managers and to educate the public about our profession. This profession requires an incredible depth of knowledge and the capacity to keep an open mind. Most days are challenging, but they are rarely boring or repetitive. It's wonderful to mentor a new person, whom you've just persuaded to take a job in risk management, and help him or her to develop over time into a true risk management professional.     

The North Carolina Obstetrics Access and Professional Liability Study: A Rural-Urban Analysis

During the 1980s a rapid rise in the costs of malpractice coverage for obstetrical services caused many practitioners to stop delivering babies. Other factors also influenced the decision by physicians to exclude obstetrics from their practices, including: increases in malpractice claims made against obstetrical providers and the subsequent fear of being sued; closures of hospital obstetrics units; issues involving Medicaid; and the daily stresses inherent in providing obstetrical care. Rural areas were particularly vulnerable to these factors. North Carolina was not unlike other states in recognizing a severe drop in access to obstetrical services in many communities, and policies were proposed to address this problem through tort reform, malpractice subsidies, and Medicaid program expansion. The exodus of obstetrical providers seemed especially critical in rural areas, and this article presents a metropolitan-nonmetropolitan analysis of the results of a survey of all obstetricians and gynecologists active and licensed to practice in North Carolina. The analysis is focused on provider responses to proposed policies and also examines the clinical support networks for these physicians to determine if this might also be an area for future policy activity. Important differences were found between rural and urban providers in terms of intensity of obstetrical practice, adequacy of backup, Medicaid participation and caseload, ideas about tort reform, and recent changes in obstetrical practice. The results indicate that policies to increase demand or income can help solve the rural obstetrical access problem but that states should pay equal attention to the clinical support system for practitioners.