WASHINGTON – When the landmark 1999 Institute of Medicine report To Err is Human revealed that tens of thousands of people die each year from medical errors, the news was not a surprise to the profession, said Elizabeth Summy, executive director of the American Society of Healthcare Risk Management (ASHRM).
The news, however, drove hospitals to articulate to themselves, policymakers and the public how they could contribute to delivering safer quality healthcare services, she said.
Hospitals took to proactively surveying their risk and protecting against any liability. The focus on risk management (RM) is especially keen, given the “incredibly slim margins” on which hospitals are operating, said Summy.
Risk managers and chief risk officers (CROs) have since taken on a larger role, impacting their hospitals’ financial picture. Risk managers and CROs wear many hats, overseeing patient safety and clinical malpractice; business processes, including workers compensation and business interruption; and financial management, processes and strategies.
The University of Michigan Health System has developed a proactive RM program based on “common sense,” said Richard Boothman, JD, chief risk officer. His more than two decades of experience as a trial lawyer defending healthcare providers taught him that learning from patient complaints could reduce future patient claims for UMHS.
Commitment to improved patient safety, accountability and patient communication is the major reason why UMHS has seen a huge drop in claims, claims to resolution and outside attorney fees. “We don’t wait for litigation to happen,” he said.
Patient complaints are routed to quality improvement measures and peer review opportunities. Claim decisions are dealt with under UMHS’s set of principles:
1. We will compensate quickly and fairly when inappropriate medical care causes injury.
2. We will defend medically appropriate care vigorously.
3. We will reduce patient injuries (and therefore claims) by learning from mistakes.
Since August 2005, the medical center’s claims have dropped below 100.
“Our average claims processing time dropped from 20.3 months to 9.5; total reserves on medical malpractice claims dropped by more than two thirds; average litigation costs have been more than halved,” Boothman said.
He did not employ risk management consulting firms or technology, but relied on his past expertise and contacts. “It was a lot of hard work,” he admitted, but it paid off, with UMHS’ risk management initiatives being nationally recognized.
Stanford University Medical Center also has a well-known risk management program, with numerous patient safety initiatives. It’s headed by Jeff Driver, CRO of SUMC and executive vice president for SUMIT.
Working with RMF Strategies, a subsidiary of the Risk Management Foundation of the Harvard Medical Institutions, Stanford uses accident causation taxonomy to analyze its closed claims. “This allows Stanford to understand from a very fundamental perspective, exactly what driving forces are behind human and financial losses,” Driver said.
The Stanford University Medical Indemnity & Trust Insurance Company (SUMIT) is the captive liability insurance company that covers medical malpractice, general, employment and miscellaneous liability of the entities and employees of Stanford’s numerous medical facilities.
SUMIT premiums are 15 percent to 40 percent below market, allowing it to invest part of that premium on RM initiatives to reduce financial loss. “Success in these efforts breeds financial success, which therefore causes a continuous performance improvement cycle,” Driver said.
Stanford’s two cornerstone safety initiatives rely on technology. EMMI Solutions provides an online education system that facilitates communication between patient and physician. “Studies show that better informed patients have better outcomes and are less likely to pursue litigation,” Driver said.
Stanford Hospital and Lucile Packard Children’s Hospital employ on-site high-fidelity simulation centers to enhance physicians’ clinical judgment and technical skills.
Over the past three years SUMIT’s strategies have resulted in improved loss ratios.
“We can count hundreds of system improvements that have been designed to avoid accidents,” Driver said. “Patients are better informed about their procedures and clinicians are even better prepared for the complexities of providing medical care by receiving advanced training utilizing on-site simulation technology.”
Overall, Summy said, “Hospital leaders today get it. They understand that any incident creates a huge impact on the community.”
Despite the advances, Summy said the industry is “just scratching the surface” of risk management.
Artromick provides medication handling systems to hospitals and long-term care facilities with the goal of improving nurse efficiency, ensuring medication compliance and eliminating medication waste. Its eMAR workflow and management system ensures enhanced workflow efficiency, medication charting accuracy and a safer medication management process.
Cerner Bridge Medical
Cerner Bridge Medical provides point-of-care patient safety software that includes bar-code scanning, expert clinical knowledge bases, wireless networking and integration capabilities to help nurses detect potential clinical errors at the patient bedside. It also provides specimen ID and data analysis services.
iMedConsent is an application that improves the education, discussion and documentation with the informed consent process for physicians, ambulatory surgery centers and hospitals.
The Risk Prevention and Management (RPM) System is an integrated suite of products that allows the capture of, tracking and analysis of medical errors, adverse events, near misses and other medical incidents.
The Doctors Company
As the first medical malpractice insurer to establish a patient safety department, The Doctors Company provides innovative products and services that reduce risk in your practice and help you avoid claims.
ECRI Institute’s experience in accident investigation, facilitation of a statewide event-reporting system, and the expertise of a staff of clinical, legal, and quality management professionals provide products and services to enhance patient safety, quality and risk management.
Emmi is a Web-based communication platform to engage patients about their health.
Emergency Physicians Insurance Company (EPIC)
EPIC takes a collaborative risk management approach to identify areas of risk and to mitigate behaviors and practices that may lead to emergency medicine errors. Through clinical collaboration, EPIC helps create, implement and share best-practices information.
Joint Commission Resources, Inc.
With one of its goals of improving the quality of patient care, this knowledge-based organization disseminates information regarding accreditation, standards development and compliance, good practices, and healthcare quality improvement. JCR provides e-learning and e-products and consulting services.
LifeWings provides aviation-based health and safety training and tools such as a comprehensive project measurement system to document patient safety, organizational improvements and ROI.
Patient Safety & Risk Solutions LLC (PSRS)
PSRS provides consulting services in the areas of enterprise risk management-business impact analysis, risk management organizational assessments, strategic planning, failure mode effects analysis, root cause analysis/critical event investigation, data analysis-benchmarking, culture analysis and accountability determination modeling, among others.
Quantros, Inc. provides enterprise-wide software for safety and quality solutions in healthcare. Products include safety and risk management, accreditation and compliance monitoring.
Software company provides applications, Risk MonitorPro, Feedback MonitorPro and Infection MonitorPro, that help healthcare organizations manage patient feedback, medication errors, adverse events, employee comments, medical incidents, claims and quality issues.
RMF Strategies provides evidence-based risk management software solutions and services to health care systems, hospitals and insurers.
The SAS Healthcare Provider Practice provides software solutions for patient safety and quality of care, financial and operational performance, and integration of clinical and business information for evidence-based management.
Financial and business processes and strategies
AIG Healthcare provides professional liability insurance for the healthcare industry. Its services include underwriting, financial strength, risk management and claims service.
Alliant Insurance Services
Alliant’s healthcare team provides risk mitigation and risk financing solutions. Its financing solutions include captives, risk retention groups, self-insured trusts and exclusive insurance products.
Aon coordinates services for risk management, alternative risk, claims management and property and casualty for physician groups, clinics, hospitals, long-term care facilities, blood banks and managed care organizations.
Arch Insurance Group
Arch Healthcare provides medical professional and general liability insurance, including excess professional liability programs for large, integrated hospital systems, outpatient facilities, clinics and long-term care facilities.
Chubb’s Healthcare Risk Management Services focuses on educating healthcare clients on risk management strategies and training through a variety of internal literature.
As a medical malpractice insurance provider, the Cunningham Group’s CARE program is based on physician-led research that helps healthcare organizations improve their risk profile and increase patient satisfaction, thereby preventing claims and improving insurability.
The IMA Financial Group, Inc.
IMA’s Healthcare practice provides customized risk management strategies. The practice has expertise in legislative issues that impact healthcare clients.
Integro Insurance Brokers
Integro’s Healthcare Practice provides risk identification and analysis, and the management of that risk through risk transfer or other financial vehicles.
For hospitals and healthcare entities, McNeary provides brokerage insurance services and programs, professional liability and workers compensation claim administration and QMS risk management software. The firm is one of the largest program administrators for hospitals and healthcare entities in the Southeast.
Marsh’s HealthCare Practice provides solutions for identification, minimization, financing and administration of risk.
NORCAL Mutual Insurance Company
NORCAL’s Risk Management Department offers programs and services to promote patient safety and help reduce policyholders’ professional liability exposures.
Watson Wyatt Worldwide
Watson Wyatt’s partnerships with insurers, distributors and healthcare providers provides consultancy services in strategy, marketing, product assessment and development, actuarial analysis and risk management, and operational assessment and design.
PricewaterhouseCoopers provides business insights and solutions from assurance, audit and tax to full advisory services.
The Tillinghast business of Towers Perrin provides risk financing design and implementation combining risk management and actuarial expertise. It also offers captive insurance company consulting and claim trend analysis and valuation of liabilities.