___________________________________________________________________________ Risk Management
When no professional or ad hoc interpreters are available, phy- sicians may be able to obtain an interpreter from a community organization. In addition, several translation businesses offer fee-based interpretation over the phone or Internet. Many of these businesses also provide translation of documents. Part- nering with healthcare plans and hospitals can help identify the best services for your practice [104]. If a patient refuses to use an interpreter, the physician should emphasize to the patient and family the importance of accurate interpretation and understanding on both sides of the patient- physician discussion. A referral to a physician who speaks the patient’s primary language may be appropriate [104]. The AMA offers several health literacy resources for health- care professionals on its website, and the U.S. Department of Health and Human Resources offers valuable information on cultural competency from the Health Resources and Services Administration (HRSA) and the Office of Minority Health. The HRSA also offers a free online course, “Unified Health Communication 101: Addressing Health Literacy, Cultural Competency, and Limited English Proficiency.” Another resource is Diversity Rx, a joint initiative of the Resources for Cross Cultural Health Care and the Center for Health Equality at Drexel University School of Public Health. Issues related to literacy and interpretation should be noted in the patient’s record to provide documentation of the physi- cian’s assessment of understanding. Strive to Achieve and Maintain Patient Satisfaction Patients who have experienced harm from a medical error are less likely to file a malpractice claim if they consider their physician to be caring or compassionate; in contrast, patients who are dissatisfied with their physician are more apt to file a claim [32; 111]. Thus, making efforts to ensure that patients are satisfied with their care is another integral aspect of a risk management program. Patients are satisfied when they feel as if they receive sufficient attention from healthcare professionals. Patients of physicians with prior malpractice claims have reported feeling rushed and ignored, being given explanations and advice that were inadequate, and having shorter office visit times than patients of physicians with no malpractice history [112]. A study of pri- mary care physicians and their patients showed that physicians with no history of malpractice differed significantly from those with previous claims in terms of the use of facilitation state- ments, the amount of information given to orient the patient to the office visit, and the use of humor [111]. In addition, the length of a routine office visit was a significant predictor of a malpractice claim [111]. Patient satisfaction can be enhanced by improving service throughout the office. Physicians should assess every aspect of the office, including the waiting room, front desk staff and procedures, billing and scheduling, and staff interactions, to ensure that patients receive a positive experience throughout
the office [72]. After these aspects have been assessed, ways to improve service should be discussed with all staff members and service should be assessed in an ongoing manner [72]. Assigning a staff member to receive and review complaints and address them in a timely manner can help mitigate patient dis- satisfaction [72]. In addition to helping to address a patient’s concern, handling a complaint also provides evidence of efforts to address the situation should a claim be presented [72]. Documenting complaints and their resolution can also serve as an important aspect of a quality assurance program [72]. Disclose Errors Numerous studies have shown that patients prefer full disclo- sure of a medical error and want details about how the error occurred, what the consequences are (including financial costs), and what measures are being taken to prevent the same error from occurring again [73; 113; 114; 115; 116; 117; 118]. Dis- closure of errors has been linked to many benefits, including increased patient satisfaction, greater trust with the physician, and higher likelihood of a patient’s positive experience, all of which are related to a lower likelihood that a patient will sue [49]. Physicians have indicated that they want to apologize for errors, but in practice, a substantial number of physicians have admitted that they did not disclose an error [114; 119; 120]. In addition, in a national survey of individuals who had experienced a medical error, only 32% said that the involved healthcare professional had disclosed the error [27]. Physicians and ethicists have long acknowledged that physicians have an ethical and moral obligation to disclose errors [73; 121]. However, for many years, defense lawyers have advised physicians to avoid apologizing to a patient for an adverse event for fear that the apology would be used as an admis- sion of wrongdoing [113; 117; 119; 122]. This approach is changing. Several professional associations and patient safety organizations have established statements endorsing disclo- sure ( Table 4 ) [26; 123; 124; 125; 126]. Legislation has also addressed disclosure, with some states requiring that hospitals notify a patient (or patient’s family) about a “serious event” in writing within a specific amount of time after the event [118]. The Sorry Works! Coalition was established in 2005 and has become the leading advocacy group for disclosure, apology (when appropriate), and compensation (if necessary) after adverse medical events [127]. Sorry Works! notes four basic facts every physician should know about disclosure [127]: • Disclosure benefits doctors as well as nurses, hospitals, and insurers. • Successful disclosure depends on overall good communication, informed consent, and excellent customer service. • An empathetic apology should be provided immediately after an adverse event. • After apologizing, the healthcare professional should immediately call a risk manager, insurance company, or defense counsel.
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