Effective hospital risk managers and executives, learn the importance of communication when it comes to preventing most lawsuits. Clear communications that can be acted upon make for more efficient and effective workplaces, but also better quality and safer care. But, is effective communication among the healthcare team enough for actually preventing avoidable injury. And, what about lawsuits or even winning a case?
Closing Death's Door to End the Epidemic of Healthcare Harm is a thought provoking book that examines the weak points in the medico-legal system and offers ideas intended to start a conversation about policies to actually lower the risk of harm to patients. It's not like those caring for patients don't want to improve. Instead, healthcare is a complex ecosystem that intersects with psychology, sociology, public policy and the legal system.
What some already know, and others need to learn, is that the traditional legal system of medical malpractice litigation is inadequate. But, where should we as communities, healthcare professionals, public policy makers, lobbyist and patients begin. To understand where we have been, are and are headed read the entire book to truly understand the layout, pitfalls and inequity that exist.
The highlights for reflection, consideration and innovation to actually improve safety in healthcare include, but are by no means limited to the following.
- The Scope of the Challenge - Understanding the scope of injury incidence and how the malpractice litigation system actually works is severely lacking. The costs are poorly understood and greatly exaggerated by healthcare industry lobbyists. Even less understood is how well, or not, malpractice litigation incentivizes investments in safety. And, conflicting motives and priorities too often go unrecognized by decision makers.
- Defensive Medicine - The authors point out that the principal gain for the provider usually said to be the goal of defensive medicine (protection from a lawsuit) is a fraudulently obtained benefit. Physicians are expected to be honest in all professional interactions and have a duty to report colleagues they find engaging in fraud or deception. Defensive medicine is not regarding responsibility to the patient as paramount, so those admitting to the practice are placing themselves at great risk.
- Tort Law Effects on Safety - If deterrence is the primary purpose of the tort system, is it effective? Well, we really don't know the answer because there are so many different systems in place across the United States. Most of the studies within healthcare and other industries are correlational (observable), not experimental findings. Ambiguity, anecdotal evidence and injury and the law's response being too far removed from empirical research create significant challenges. "An unpredictable lottery" is one of many ways the authors describe the tort litigation system and healthcare leaders will have to agree it is highly variable and unreliable.
- Error Reporting - And then there is the "flawed panacea" of error reporting internally within healthcare organizations and externally to accreditation and regulatory bodies. No one wants or like to report medical errors and the humans that make up the system too often look for and find ways to not, or underreport. Those who have sat in on meetings with medical staff and administrators over years have seen the conflict, fear, resistance, attempts to rationalize and desire to not harm the career/livelihood of "good doctors" and other clinicians.
There is no "solution" offered in this book. Instead, illustrations, suggestions and possibilities are offered to help us move "beyond the endless tug of war to weaken, or restore, or tweak the malpractice litigation system." Reflection, innovation, experimentation, thoughtfulness and evidence-based evaluation research is needed to help us craft new health reform. And, the process must be interdisciplinary and collaborative (legal policy makers, economics, statistics, cognitive and behavioral sciences, human factors, clinicians, healthcare management and other disciplines) to avoid the mistakes in planning that lead to unintended consequences.
Most importantly, stakeholders and the laws created need to be focused first, last, and insistently at promoting safety; especially those desiring to reduce costs.
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