© 2008 The Board of Trustees of the University of Illinois The Seven Pillars Approach: Crossing the...

The “Seven Pillars” Approach:Crossing the Patient Safety – Medical

Liability Chasm

Timothy McDonald, MD JDProfessor, Anesthesiology and Pediatrics

Interim Assistant Vice President for Quality and SafetyUniversity of Illinois Hospital and Health Science System

PI: R18

Grant announcement

AHRQ/Seven Pillars Project focusPatient Safety first – eliminate harm Improve communicationReduce preventable injuriesCompensate patients/families fairly and timelyReduce medical malpractice liability

Some background

Institute of Medicine:1999 report that shook the medical world

Making Matters Worse

February 2012, Volume 31, Issue 2

Part of the issue

Adding to the equationJournal of Trauma, September, 2010

• 8% of physicians generated 34-40% of unsolicited patient complaints

• Same 8 % generate 50% of risk management expenses• Physicians in bottom q-tile of patient satisfaction have 110%

malpractice risk

More value to communication

July 2011, Volume 30, Issue 7

• 70% of claims dropped once information shared

2005 U of I leadership approves “communication- resolution” program to attack medical malpractice crisis

Comprehensive program created Integration of safety, risk, quality and credentialsLinkage to claims and legal – deal with the fearsLongitudinal patient safety education plan

UGMEGMECME

A Comprehensive Response to Patient Incidents:The Seven Pillars. McDonald et al Quality and Safety in Health Care, Jan 2010

Reporting InvestigationCommunicationApology with remediation – including waiver

of hospital and professional feesProcess and performance improvementData tracking and analysisEducation – of the entire process

Goals of the Seven PillarsReduce harm thru transparency and learningReduce lawsuits through early, effective

communication with all partiesResolve inappropriate care cases early, efficientlySupport patient and family engagementSupport care professionals following harm events

The Seven Pillars:A Comprehensive Approach to the Prevention and

Response to Patient Events

Unexpected Event reported toSafety/Risk Management

Patient Harm?

Consider “Second Patient”Error Investigation

Hold bills

InappropriateCare?

Full Disclosure with Rapid Apology and Remedy

Process Improvement

Data Base

PatientCommunicationConsult Service

24/7Immediately

Available

“Near misses”

Activation of Crisis Management Team

The Patient Communication Consult Service [PCCS] PCCS – immediately available 24/7 Current options Empowerment Value of Emotional Intelligence Expectations Physician involvement Patient-family involvement Mitigates impact of “special

colleagues” with low EI

Establishing a PCCS Leadership buy-inEstablish policy, procedure

Rapid access 24/7 – hotlineJust in time training for those who access hotlineCommand and controlEstablish the “liaison”Goal - to maintain trust and to learnHelp/support physicians overcome their fears

The Seven Pillars:A Comprehensive Approach to Adverse Patient Events

Patient Harm?

Hold bills

InappropriateCare?

Process Improvement

Data Base

24/7Immediately

Available

“Near misses”

Elements of resolution/remediation• Patient Safety Compensation Card – given to

patients if harm caused by inappropriate care, serves as their ongoing “insurance card”

Putting it all together

October 7, 2011

Another communicating openly and resolving early

October 7, 2011

The Seven Pillars:A Comprehensive Approach to Adverse Patient Events

Patient Harm?

Hold bills

InappropriateCare?

Process Improvement

Data Base

24/7Immediately

Available

“Near misses”

Process improvement:Significant change in national guidelines

July 1, 2011 ASA Specifically, in section 3.2.4 of the Standards for

Basic Anesthetic Monitoring, the ASA states, "...During moderate or deep sedation the adequacy of ventilation shall be evaluated by continual observation of qualitative clinical signs and monitoring for the presence of exhaled carbon dioxide unless precluded or invalidated by the nature of the patient, procedure, or equipment.

The Seven Pillars:A Comprehensive Approach to the Prevention and

Response to Patient Events

Patient Harm?

Hold bills

InappropriateCare?

Process Improvement

Data Base

24/7Immediately

Available

“Near misses”

Pillar #6 Data

Educating the next generation:Reporting Data from Resident Physicians

Reporting established as an expectation and part of Core Competency assessment

Resident physician occurrence reporting dataJournal of Graduate Medical Education, June 2010

Event data

Communication Consults

UHC Derived Safety Data

ROI for institutions:Improving safety reduces liability

“Reducing Patient Safety Incidents by 10 decreased claims by 3.9.”

http://www.rand.org/pubs/technical_reports/TR824.html

Impact of comprehensive effort Increased reportingRapid, effective ongoing communicationRapid cycle improvements and harm preventionEarly resolution

Other data updateMedical Malpractice Premium dataOverall reduction on premium over past three

years = $22MMFY 11 - $4.7MM less than FY 10FY 12 - $7.4 MM less than FY 10FY 13 - $10.1MM less than FY 102006 – SIP $45MM underfunded2012 – SIP $8MM in excess

Waived hospital and professional fees

Hospital fees waived in first 8 months: $2.29MMProfessional fees waived in first 8 months: $110KTotal savings to payors in 8 months: $2.40 MM45% Medicare/Medicaid

Other stakeholder buy-in prior to grant

Medical SocietiesProfessional liability companies – hospital and

physicianHospital AssociationLegal groupsConsumers Advancing Patient SafetyProject Patient Care Individual hospital boards, medical staffs

AHRQ Grant10 private hospitals, self insuredOpen medical staffs, private professional

liability coverage7 from faith-based system2 from a “for profit”1 underserved inner cityMost with resident physicians

Collaboration with Professional Liability Insurers

Update from grant hospitals Intervention [5] hospitals rolled out Hospital and physician leadership fully engaged Tools created or employed

gap analysis tool; videotaped communication training materials; EI assessment tools; RM/Investigation checklists; resident reporting training materials

Gap analyses completed Communication training complete On-line occurrence reporting begun Disclosures, early offers have occurred Data being analyzed Control [5] hospitals roll out in August 2012 Have been asked to work with > 20 hospitals in three other states since

commencing grant

Data from one grant hospital• Large reduction in serious reportable events• Already experiencing reduction in liability claims• Have waived > $150K in Medicare charges

Intervention

Update on other dissemination and collaborative efforts “Tiger” with CMS Hospital Engagement Networks – AHA HRET The Joint Commission – surveyor training MedStar

Co-Investigator, Dave Mayer MD, appointed Senior VP for Quality and Safety, May 15 meeting

Hospital associations/systems Illinois, Maryland, Colorado, South Carolina, New York

Medical Societies Illinois, Colorado, Wyoming, Florida

Professional liability companies ISMIE, COPIC, Mag Mutual, The Doctor’s Company

Questions?

© 2008 The Board of Trustees of the University of Illinois The Seven Pillars Approach: Crossing the...

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