Full disclosure may equal decreased claims
It's not all about liability when it comes to admitting medical mistakes, and it's not all about the increase or decrease of lawsuits and, thus, costs. Disclosure following a medical error "is the right thing to do," says Richard C. Boothman, chief risk officer at the University of Michigan and a co-author of a recent article in the Annals of Internal Medicine.1 Boothman's, and the University of Michigan Health System's, policy to offer full disclosure and compensation to patients after a medical error has proved its mettle, and Boothman's philosophy.
In the retrospective, before-and-after study of the program that started in 2001, claims from 1995-2007 were reviewed. After the program's implementation, the study found, the average monthly rate of new claims decreased from 7.03 to 4.52 per 100,000 patient encounters. The average monthly rate of lawsuits decreased from 2.13 to 0.75 per 100,000 patient encounters. Median time from claim reporting to resolution decreased from 1.36 to 0.95 years. Average monthly cost rates decreased for total liability, patient compensation, and non-compensation-related legal costs.
Before entering the University of Michigan system, Boothman practiced for 22 years as a defense attorney. When he entered the system in July 2001, he says, "I was well known here, and though people may have thought I had lost my marbles a little bit the first time I said we should talk to people who are threatening to sue you rather than stonewall them, I don't think they ever doubted my expertise or my ability to reassure them it was the right thing to do," he says. The system started small but immediately saw positive results with savings in claims and a receptive audience with both physicians and the medical community in general, he says.
He says the legal community has created a sense that if something is wrong, a disastrous catastrophe is right around the corner, despite the fact that he thinks health care providers believe that they should and want to be open with patients. The single most important takeaway from the article, he says, is "that we can do this without having the sky fall in."
"What I was nervous about in publishing that paper was that we would only fuel the notion that apology saves money and that that's the end of the conversation," he says, noting that the real job of risk management is safety and not repeating mistakes. "The real importance of transparency is not just in the savings you get case by case; the real importance is that it is a necessary trait of any health care institution that wants to improve. You can't tackle a problem if you don't acknowledge a problem to start with. I think that's the point that keeps getting missed in all these stories."
To improve quality and safety, he says, administrators have to get over the fear of the threat of litigation. And in this way, he sees a growing convergence between risk management, quality improvement, and patient safety. "The concepts of risk and quality are clearly converging these days, and I think that's the way they should go." He sees his role as blending the risk management and quality "into a core corporate quality approach rather than seeing risk management as a janitorial service just to mop up after something bad happens."
The trend of doctors putting their hands up after a true error has occurred and saying, "Talk to my lawyer" has created what he calls a "funny, self-imposed cycle." What else is a disgruntled patient to do but sue? In the disclosure movement and flurry of suits, finances, and worry, a lot gets lost. "[T]he more important message," he says, is "that if caregivers don't abdicate their responsibility when something goes wrong, we've found we can restore patient relationships or maintain them." Patients are more forgiving than the industry thinks, he says, and in settling after a true medical error, when you're not paying for all the time and the transactional expenses, you have a much better outcome.
Ultimately, though, he says, you have to spot the difference between a medical error and reasonable care that had a bad outcome. At the University of Michigan health system, it is clear that legal staff are there to support medical staff and those staff are heavily involved in analyzing and situations, he says. In the end, he says, it's about doing the right thing.
Reference
- Kachalia A, Kaufman SR, Boothman R, Anderson S, et al. Liability claims and costs before and after implementation of a medical error disclosure program Ann Intern Med. 2010 Aug 17;153(4):213-21.
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