___________________________________________________________________________ Risk Management
The following are among the most important issues related to risk management [9]: • Communication (with patients and among staff and other healthcare professionals) • Missed appointments • Follow-up on test results • Documentation • Management of medications
INTRODUCTION Risk management in the healthcare professions refers to strategies designed to enhance patient safety, decrease the risk of malpractice claims, and minimize loss. Effective risk management is essential not only because of the inherent value of patient safety but also because of the high prevalence of malpractice claims, which exact great costs in terms of money, time, and personal and professional losses [1; 2]. Healthcare institutions implement interdisciplinary risk management programs to ensure that high-quality medical care is provided to patients and to reduce the risk of malpractice claims brought against the institution and/or its attending physicians and other healthcare professionals. While physicians in surgery and obstetrics/gynecology are most likely to be named in a malpractice suit, primary care physicians in private practice are very vulnerable to malpractice claims and often face greater professional and personal consequences of a malpractice suit [3; 4; 5]. Thus, this course primarily addresses risk management programs for healthcare providers in private practice. The course begins with a definition of risk management, emphasizing the need for primary care physicians to establish risk management strategies in their practice. A definition of tort (personal-injury) law and several legal issues related to malpractice lay the foundation for a better understanding of such key concepts as medical negligence and the standard of care, adequate informed consent, and malpractice-related laws such as apology statutes, Good Samaritan laws, and charitable immunity laws. The focus is on the issues that cause the most common allegations in malpractice claims in the United States [6]. Descriptions of the common characteristics of malpractice claims and the consequences of malpractice are included to enhance healthcare professionals’ understanding of the underlying causes and motivations of malpractice claims. Such an understanding can help physicians develop targeted risk management strategies and enhance patient safety, and a variety of proven strategies to avoid malpractice are discussed. DEFINITION OF RISK MANAGEMENT Risk management is a program of strategies to minimize the risk of harm to patients and to decrease the healthcare provider’s exposure to liability. An effective risk management program includes both proactive and reactive components [7]. The proactive component consists of strategies to prevent adverse occurrences, and the reactive component includes strategies for responding to such occurrences (i.e., minimizing loss). Minimizing loss involves developing a process to handle a malpractice claim as efficiently as possible. Quality assurance is also an important factor in risk management, as improving the quality of medical care is the theoretical underpinning of avoiding malpractice [8].
• Patient satisfaction • Scope of practice • Disruptive patients • Patient termination • Medical record retention
In addition, in 2014, the American Society for Healthcare Risk Management developed a holistic approach to risk management called enterprise risk management that includes traditional reactive strategies combined with proactive strategies. The following eight risk domains make up enterprise risk management [10]: • Operational • Clinical and patient safety • Strategic • Financial • Human capital • Legal and regulatory • Technological • Environmental- and infrastructure-based hazards Surveys of medical office practices have shown that problems related to risk management are common across all physician specialties [5]. These problems warrant attention and improvement efforts not only because they are associated with a risk of malpractice but also because they have the potential for causing medical errors, which have been reported to be highly prevalent and highly preventable [11]. An overall understanding of malpractice and its key components is needed to provide a framework for defining and discussing effective risk management strategies. ANATOMY OF MALPRACTICE Physicians are the primary target of malpractice. According to records of malpractice payments in 2024, 81.9% of payments were made in claims against physicians and dentists; professional nurses accounted for 7.9%, and all other healthcare practitioners constituted 10.0% [12]. In total, 34% of physicians have been sued, with 16.8% having been sued more than twice [13]. Lower quality of care does not appear to be the cause of most malpractice claims, as no significant differences have been found in quality between physicians who have and have not been sued [14].
21
MDMI1826
Powered by FlippingBook