May 20, 2013
ATLANTA - Professor Charity Scott, director of the Center for Law, Health & Society, spoke at a recent meeting of the Medical Association of Georgia (MAG). She outlined several new approaches being undertaken by hospitals across the country to resolve potential claims of medical malpractice before the parties are embroiled in lengthy and expensive litigation.
"The traditional litigation model of claims resolution in health care is reactive and defensive," said Scott. "Litigation not only is extremely costly in terms of money, time, and reputations and takes a heavy toll psychologically and emotionally on all concerned, it also does little to actually improve the quality and safety of patient care for the future."
The new models that are emerging rely on prompt internal reporting and investigation of all adverse events that may signal a medical error has occurred in a patient's care and on prompt disclosure of such unanticipated outcomes to patients (and their families when appropriate). If the hospital determines that unreasonable care was provided – that is, below the medical standard of care under the circumstances – then the patient receives an explanation as to how the error occurred, how its effects will be minimized, and what steps will be taken to ensure it does not happen again.
Where determined to be appropriate by the hospital's claims committee, patients are also given an apology and an offer of fair compensation to cover expenses for future medical care and other damages without having to bring a lawsuit to receive compensation.
Leading hospitals that are taking this approach include the University of Michigan Health System, the University of Illinois Medical Center at Chicago, 16 Harvard hospitals in Massachusetts, and other academic medical centers at Stanford and Johns Hopkins. "This approach has also been endorsed by many national health care professional societies," observed Scott. "It reflects the ethically right thing to do."
The attendees at the MAG meeting had questions about the impact on liability and insurance costs. According to Scott, initial information provided by the health care centers adopting this approach show significant savings by reducing the number of cases in litigation, the costs per claim, the time to resolution, defensive medicine costs, and insurance costs. The Agency for Healthcare Research and Quality has funded seven demonstration grants around the country to test the impact of this model on costs, patient safety, and other factors in health care delivery. "We'll have better national data soon that will help quantify the actual effects of these programs," said Scott.
One of the key reasons to implement an early resolution program – often called "disclosure-apology-and offer" programs – is to systematize the reporting of adverse events and improvements in patient care within the hospital. The collected data can be analyzed and shared internally to improve health care providers' performance and overall systems of care for patients.
"Good conflict management systems are proactive and intervene before problems escalate, anger and frustration set in, and positions become hardened," Scott reflected. "These early-resolution approaches hold great promise both for expeditiously handling potential claims as they arise and for improving the quality and safety of patient care for the future."
Associate Director, Center for Law, Health & Society