A results-driven risk management program: one surgical group's success story.

Health care provided in physician offices represents the most widely used segment of our U.S. system; however, the physician office setting has not yet received nearly the same amount of attention with regard to risk management and patient safety that hospitals and health care systems have.1 A recent study indicated that an estimated 75,000 hospital discharges annually were related to preventable adverse events that occurred in an ambulatory care setting.2 These preventable events contribute not only to the rising costs of health care across our nation but to the medical liability crisis and tort reform. It is estimated that $55.6 billion is spent each year on the interrelated combination of medical liability litigation and defensive medicine.3 In this environment, a culture of patient safety and risk mitigation must be created and emulated from the top down.4 With the financial implications and other costs associated with professional liability claims, it is important to understand what truly causes claims so that methods of prevention to reduce risk can be followed.5 Empirical evidence suggests that the majority of malpractice claims are not the result of clinical negligence.6 Most malpractice claims are the result of non-clinical activities: communication lapses, poor documentation, unclear or non-existent informed-consent policies and procedures, as well as other system errors. In addition, for every claim, there are likely many nearmisses or events with less severe outcomes that can be related to process errors similar to those that resulted in malpractice claims. Understanding patterns of malpractice claims and related events can facilitate identification of high-risk areas and accelerate the development of programmatic interventions to improve patient safety and mitigate risk.7 In 2006, the Connecticut Surgical Group, a group consisting of 45 physicians practicing in nine specialties, implemented a multi modality risk management education and practice change program that focused on enhancing the organization’s patient safety culture, and reducing the organization’s malpractice exposures and claims while improving the quality of patient care and overall patient safety. Traditionally, risk management strategies are applied to hospital inpatient settings.8 With this in mind, at the onset of the program there were concerns regarding the overall receptiveness to the program, compliance and behavioral change. Several years later, the results-driven program, initially deployed to surgeons only, has grown to include all mid-level providers, nurses, practice managers, office staffers and administration. The program continues to provide participants with a broader knowledge base in risk management, which has resulted in sustained practice changes, reduced malpractice exposures and an improved culture of patient safety.