Reducing the likelihood of malpractice claims

Healthcare providers are faced with several challenges throughout their careers.

Medical malpractice claims may top the list, especially in today’s healthcare environment where tighter regulations are increasing providers’ exposure to risk.

That is not to say that providers aren’t doing their jobs to a certain standard. In fact, even when care exceeds professional standards and is given in a high-quality, accredited hospital with excellent regulatory scores, providers are still at risk of being sued. Namely, because most claims come from patients or patient’s family members, not from regulators. So, despite adherence to regulations and standards, exposure to risks still exist.

For that reason, disclaimers are given at various touchpoints to help to protect providers from liabilities and ultimately reduce claims. The catch? Disclaimers may not address unrealistic expectations of outcomes or lessen unsettled feelings from the patient and his or her family members. If an effort to appease this, providers will often insist on additional testing with the hopes that these added precautions will alleviate those issues, which comes at a cost and puts the providers clinical knowledge into question.

Instead, providers should focus on these better approaches to reduce the likelihood of being sued.

Relationship building.
The most common factor impacting whether a provider is sued for malpractice is a patient’s, or family member’s, perception of whether the provider genuinely cared. This is often the result of a negative perception of the care delivered.

Maintaining a positive relationship with the patient and his or her family members is key to avoiding this. Providers can do this by showing compassion and empathy throughout the patient’s care. Being personable and present is also important.

Malpractice claims also stem from a breakdown in patient-provider communication. So, it is important for providers to establish open lines of communication with the patient and the patient’s family members. By doing so, patients and their family members ultimately feel like the provider took the time to answer questions and address concerns.

While some of these conversations can be difficult, especially when it comes to addressing the potential of complications, it is imperative to communicate these messages regularly. This will ensure all parties are aware of the risks associated with the care and helps avoid any miscommunication.

In addition, one of the most critical factors in ensuring strong communication with patients is obtaining adequate informed consent. Informed consent should be a two-way conversation, not a lecture given by the provider.

Another trigger for malpractice claims is when a patient or a patient’s family member feels that they have been wronged by something a provider did. In most cases, this is the result of a lack of understanding of the processes and regulations in place. Instead, the patient or family members base their knowledge on assumptions, what they read online or what they may have heard in passing from others.

Providers need to take the time to educate patients, and the patient’s family, about the side effects and the risks associated with each treatment option. Education is also important when explaining the logic behind what medical tests are appropriate, rather than ordering additional tests just to appease the patient or a family member.

This will help to explain the reasoning behind the recommended care plan and will make the patient, and the patient’s family, feel like they are involved in care decisions. By taking the time to educate patients on processes and regulations, providers can save time from having to justify their actions down the line.

Coupled with communication and education, providers need to document all verbal interactions between the care team and the patient and his or her family members. Unfortunately, the rationale behind certain decisions regarding care can go undocumented because it was a conversation had between the provider and the patient, not a written plan. But in reality, this should be a crucial part of the record.

Rather than dealing with the he-said-she-said argument, documentation serves as a proof point of verbal interactions made during the care plan should a claim be filed. For example, documentation should include the rationale of the provider’s decision and the understanding of potential complications from the patient’s side. Including reports about how the patient is feeling about the care he or she is receiving is also important.

Additionally, because patients often have interdisciplinary teams providing care, it is essential that notes are shared with and read by the entire team to ensure all those involved in the care are on the same page.

While these preventative tactics can help to reduce the likelihood of malpractice claims, providers are never really out of the woods. That is why hospitals and health organizations partner with insurance brokers. By working with an insurance broker, healthcare providers can ensure that they are providing high quality services, adhering to regulatory standards and are following best practices to communicate with patients.

If a situation occurs that could result in litigation, providers should contact their insurance broker right away to alert them of the potential claim. This will help to guarantee that the right coverage is available if the lawsuit is filed and allows the insurer to quickly retain an attorney to assist with the claim.

Bette McNee, RN, NHA, is a clinical risk management consultant at Graham Company. She works within the rapidly expanding Health and Human Services Department as a trusted resource for regulatory and compliance issues, helping clients to improve outcomes and navigate the ever-changing industry.

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