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Medical Malpractice: Three Myths That Cost Your Hospital Millions
What's the use? Nothing you do will hold down the cost of medical malpractice. It feels that way sometimes, doesn't it? Unfortunately, for many risk managers, that's not too far off the mark. What they're doing isn't working. We can point to other industries, greedy lawyers, insurance companies trying to make up for losses in the stock market. But there's trouble within medical practices too. A study published in the Archives of Internal Medicine showed that many of the actions risk managers take actually backfire(1). They create more risk and drive up costs. The problem is not the risk managers. It's myths about medical malpractice that dominate the healthcare industry. Three myths in particular are common and costly. Myth #1: Medical negligence causes medical malpractice claims. What could be more logical? It's a conclusion based on common sense and backed by data from two large studies carried out by Harvard researchers over the past 20 years. One percent of hospital visits end in medical negligence. And the injured one percent are 20 times more likely to claim medical malpractice than are the other 99 percent. So patients injured through error must drive malpractice claims, right? Wrong. A recent report from researchers at the Harvard School of Public Health(2) revealed that four of five patients who file medical malpractice claims have not been injured through negligence. And the great majority of patients who have suffered negligent injury don't sue. Myth #2: Medical malpractice claims are random acts If medical error doesn't drive malpractice claims, what does? Maybe claims are entirely unpredictable. They're not though. Injured patients are 20 times more likely to sue than are patients who aren't injured. And there are correlations that are far stronger that we'll discuss in a minute. Myth #3: Medical malpractice claims are filed by opportunistic patients Undoubtedly some are. I've heard from risk managers, especially in economically depressed areas, who feel the pinch from patients who literally fall in the parking lot. Personal anecdotes like these though can be misleading. According to Beckman and colleagues in the Archives of Internal Medicine(3), the reality is that most patients sue because of emotional errors. They feel deserted, feel their views were devaluated, feel that information was delivered poorly, and feel their physician failed to understand their perspective. And this is why the strategies pursued by many risk managers backfire. They've been led to believe that opportunistic patients take advantage of errors and negligence as an opening to sue. So they follow what seems to be the logical course of action. They keep the physician from the patient and withhold information. Sometimes they even mislead patients. All of which fuels the patients' feeling of having been wronged. So what can you do? Equip your staff, particularly your physicians and risk managers, to treat patients with empathy and respect. Even if they threaten to sue. Especially if they threaten to sue. The Harvard School of Public Health will tell you that if your aim is to prevent liability loss, you may have more success communicating well and showing patients you value them than you will by reducing actual cases of malpractice Of course, that's easier said than done. There are two reasons. First, it's stressful being face-to-face with someone who's upset. Most people intend to be open. But they're afraid it would make matters worse. Second, though most medical staff are compassionate, they don't know how to express that empathy in a way an upset patient can see. Instead, they try to fix the problem or show the patient the right way of thinking. Which does make matters worse. My advice? Your best course of action is to get out ahead of the problem. Train your staff to identify patient feelings and needs, and negotiate solutions. So patients feel no need to make claims in the first place. If that seems like a lot to bite off. Here are some suggestions to get you started. Train selected staff. Risk management, security services, and social work, work often with upset patients. Focus on staff in these areas to leverage a limited training budget or to model the skills for other employees. Train selected departments. Some departments, obstetrics and neurology for example, attract medical malpractice suits. In the case of medical malpractice, the best defense is not a good offense. It's good collaboration. Your goal is to uncover your patients' needs and negotiate solutions that meet their needs as well as the needs of your hospital. And do it in a way your patients can see._______________________________________________________ 2. Medical malpractice as an epidemiological problem, Social Science & Medicine, Volume 59, Issue 1, July 2004, Pages 39-46, Michelle M. Mello and David Hemenway 3. Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. Arch Intern Med. 1994;154:1365-1370 Tim Dawes, founder of Interplay, Inc., specializes in helping health care organizations exceed their strategic goals by demonstrating unexpected empathy to patients. Sign up for free monthly "how to" articles at http://www.interplaygroup.com
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Dont Let Your Measurements Mislead You Don't Let Your Measurements Mislead YouThere aren't too many words that can strike as much fear and loathing into the hearts of your internal customers, and sometimes your own employees as the words "Operational Measurements". Operational Measurements often get a bad rap because of their misuse by well intended, but misinformed management. And it's easy for your employees to view Operational Measurements as some kind of cheap trick to force more work out of them as you constantly try and force more and more production from your team. Meanwhile, your sales team thinks that you will use Operational Measurements to cloud the issue of customer satisfaction by pointing to your "great numbers" while leaving the customer very unhappy. The truth is that you cannot succeed in managing an operational organization without the proper measurements in place. Any attempt to run an organization without them is doomed to failure because you will lack the fundamental information required to manage your business. Coach Dave is a strong believer in Operational Measurements because he knows that the right measurements, taken in a consistent fashion will allow you to continuously improve the performance of the organization and the company. Yep, Operational Measurements are good. . . . except of course, when they are bad. In simple terms, Operational Measurements are progress meters that can tell you how well, or how poorly your group is performing. The key to successful Operational Measurements is to make sure that you are managing and measuring your key processes. It all starts with your departmental or company objectives. You should have 2 to 3 major objectives, depending upon the size and scope of your organization. The key is to focus on whatever it is that you are really being asked to deliver on, and then set up your objectives, and Operational Measurements in a way that can tell you if you are succeeding or not. If your objective is production based (i.e. produce 50 widgets per month) then make sure that your measurements track the number of widgets produced. If your measurement is time based (i.e. complete widgets within 10 days of receipt) then once again, make sure that your measurement tracks to the objective. You would be surprised how easy it is to create measurements that sound important, but have nothing to do with your stated objectives. For example, if you goal is to paint 10 houses each month a metric that tracks how many brushes you use may sound important for cost control purposes, but it really has nothing to do with the objective. By focusing on the number of brushes you use, you may actually impede your ability to complete the goal of 10 houses. Ensuring that your objectives and measurements are in synch will keep you and your department focused on the prize. Once you have your key measurements in place, you can start to look for a pattern in the results. If you are not able to meet your objectives, the question has to become "why". It could be a variety of factors from bad inputs, to bad processes, to bad people. To determine where the problem is, break out your measurements in that area to each key step in the process. As you examine those results it will become more apparent that "step 5" takes up 80% of the processing time. Then you can focus on reducing the time spent on that step. One other key factor to account for as you measure your process steps is "wait time". "Wait time" doesn't always manifest itself clearly in reporting, so spend the time to analyze how many handoffs exist in your process and ask yourself and your staff if some of those handoffs can be eliminated through combing functions, training, etc. It is simply amazing the amount of time lost in a process due to the "wait time" while an order is sent from one person to the next. Reducing the "wait time" can dramatically improve your results. In a nutshell, that's why you need to have good, clean Operational Measurements in place. Many of the things you can count, don't count. Many of the things you can't count, really count. - Albert EinsteinAny time your organization receives some kind of a work order from a customer (internal or external) adds value to it, and then either completes it or passes it along to another organization, you qualify as an Operational Organization. As an Operational Organization you need to have solid measurements in place to measure, validate, and eventually improve your own internal processes. But there is a downside to Operational Measurements as well. The downsides can take many forms, but the most common are when you start to measure everything that you do, simply because you can. Also, when your measurements rather than your customers, begin to drive how you do business. Are you counting the right things? The right way? Are you counting so many things that counting them has turned into your primary business? Are you helping your customers, or hurting them? That's the difference between good Operational Measurements, and bad ones. When Operational Measurements Go Bad: When you first implement your Operational Measurements, you will spend a lot of time analyzing, improving, and tweaking them. The painstaking process of developing and implementing the right measurements requires a lot of time up front. But that time is time well invested to make sure your measurements are complete, accurate, and in synch with your organizational objectives. You must spend the necessary hours making sure that your Operational Measurements track to your objectives, that they provide a consistent measurements, and that they are at the appropriate level of detail to allow you to identify weaknesses in your operation, and implement improvements. But, when you find yourself counting things because you can, or you begin adding measurements that do not relate to your objectives that's the first sign of trouble. Also, when your Operational Measurements become the sole driver in your organization, that's a pretty good sign that you've turned the corner and are headed down the wrong path. Remember, not everything that counts, can be counted. And just because you can count it, doesn't mean you should count it. Let's use the example we previously discussed of a house painter. For our purposes here, this is a big house painting company with multiple crews who do different types of painting. At the start of the year the decision is made to set a new objective for your crew. You are now being asked to paint 13 houses per month with the same size crew, up from just 10 last year. You sit down with your crew and begin to look for ways to improve productivity. You make the necessary changes to your team or process and then set out to accomplish your new goal. Your changes are effective and productivity improves and you start reaching your new goal. Then, a funny thing happens. You get a memo from your boss that goes something like this. "The bean counters tell me that your paint brush usage is up 15% above last year. Every dollar counts, so I'm putting together a special task force to cut the number of paintbrushes being used. We need to reduce our paint brush usage to 10% below last years level within 30 days." And . . . . we're off . . . . this is what I sometimes refer to as "The Operational Measurement Shuffle". What is the Operational Measurements Shuffle? It's a dance that management sometimes does where we lose focus on our objectives and instead start dancing with a lot of extraneous information that may LOOK important, but really isn't. Sometimes it's not entirely clear when the Operational Measurements Shuffle actually begins. But if you pay attention, you'll see the dance by the end of the first chorus. We're now going to start counting things (paintbrush usage) that has nothing to do with our objectives, but that looks important to someone else far away. Notice that the boss didn't ask you to explain why paintbrush usage was up, nor did he look at the cost/benefit of paintbrush usage versus revenue, he just told you to reduce the usage. You can expect this new measurement to be followed by new measurements of the painters' hats being used, the amount of thinner being used, and questions about the number of rungs required on the ladders. And lastly he blamed the "bean counters". The uninformed always blame the bean counters. At first glance you might think that it's ok to wonder about the paintbrush usage. And it is. But there is a difference between asking a question, and putting in new measurements to track them. For example, a smart boss would have called and asked about the increase in the number of paintbrushes being used. Your response might have been something like this. "That's right. Our paintbrush usage is up. In order to meet our goals for the year (13 houses per month) we made a change from regular paintbrushes to disposable paintbrushes. The new brushes cost 30% less than the old ones, plus we save on turpentine, and clean up time at the end of each day. 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