Risk Management _ __________________________________________________________________________
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]. 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
gies. 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 improve- ment 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 preva- lent 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 manage- ment 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; profes- sional nurses accounted for 7.9%, and all other healthcare practitioners constituted 10.0% [12]. In total, 34% of physi- cians 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]. For physicians in low-risk specialties (e.g., pediatrics, psychia- try), there is a substantial gap between physicians’ perceived risk of malpractice and their actual risk, with physicians perceiving a much greater risk of malpractice than has been documented for their specialty [15; 16]. For example, in a survey regarding malpractice concerns, 62.5% of pediatric physicians agreed or strongly agreed that they were at risk, compared with Ameri- can Medical Association (AMA) data that indicated 17.8% of pediatric physicians had ever been sued [13; 17]. Similarly, radi- ologists have estimated their risk of litigation within five years as 35%, which compares with an actual rate of approximately 10% [15]. By contrast, using the same datasets, physicians in high-risk specialties (i.e., obstetrics/gynecology and surgery) had a much closer concern/reality gap, with concern data showing 81% for obstetricians/gynecologists and 75.3% for surgical specialists, compared with a lifetime malpractice claim rate of 63.6% and 63.2%, respectively [13; 17].
• 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 strate-
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