Ann Arbor-based University of Michigan Health System has been widely recognized for its innovative medical error disclosure policy called the Michigan Model. In the case of an error or complaint, a team of professionals analyzes the situation to determine the cause of an event. If the team determines there was a medical error or care was inappropriate, the providers apologize and work with the patient to reach a joint solution. If the team determines care was medically appropriate, UMHS explains the case to the patient and defends its providers.
Since UMHS began this approach in 2001, the number of pre-suit claims and pending lawsuits dropped approximately 61.5 percent. In addition, UMHS decreased its average legal expense per case by more than 50 percent since 1997, including a savings of $2 million in the first year alone of the Michigan Model.
What disclosure is really about: Safe patient care
While these results are impressive, the true value of the program is in higher quality and safer care, according to Rick Boothman, JD, chief risk officer of UMHS. "It is important to understand that our approach is not just about achieving savings in claims; at the heart of our approach is a deep commitment to learning from our mistakes and improving the quality of our care," he says. "Transparency is not just a strategy for handling claims. The core value of transparency is that it is absolutely necessary if we're going to improve the quality of medical care."
Replicating the Michigan Model
Here are some tips to implement a transparent medical error disclosure policy in a hospital or health system.
1. Communicate the benefit to providers. Being honest with patients about medical complications, whether due to a provider error or not, benefits both patients and providers. When a mistake is made, being honest with a patient enables providers to learn from their error. When providers did not make a mistake, acknowledging this fact instills confidence in them.
Being honest with patients can also save providers from needless litigation — an outcome opposite of many people's expectations, according to Mr. Boothman. "We didn't open a floodgate of claims by admitting we've had our own share of problems," he says.
2. Designate a physician advocate. Hospitals should designate a leader in the risk management department to be a physician advocate to encourage openness. "I have never advertised myself as a patient's advocate," Mr. Boothman says. "I know what I'm doing directly benefits patient care and patients, but it's important for me to say to staff, 'I 'm here for you.'" Having someone to support providers through the disclosure process is critical for building trust with providers and encouraging openness.
3. Ease others' fears. One of the biggest challenges to implementing a transparent disclosure policy is resistance from people who feel their job is threatened by a new approach to medical errors and malpractice, according to Mr. Boothman. Hospitals' defense lawyers are typically the most resistant to this change, possibly because they believe their job may not fit in the new model, he says. "The industry, which has been built around a deny-and-defend mentality, is very threatened by this. But if our heart is in the right place and we want to do the right thing by our clients — doctors and hospitals — [the transparent approach] makes too much sense," he says.
4. Consider the role of insurance. UMHS is self-insured for malpractice insurance, which, while not a requirement for its disclosure model, does make the policy easier to implement, according to Mr. Boothman. First, being self-insured guarantees that the malpractice claims policy aligns with a goal of quality care. "An independent insurance company does not have the same interest that a self-insured institution like ours would have in terms of an abiding interest in quality of care," Mr. Boothman says. In addition, being self-insured eliminates the challenges associated with working with an outside company. "We don't have another corporate voice to deal with," he says.
Committing to medical error transparency
Ultimately, committing to transparency with medical complications and errors is critical to improving quality and patient safety, and has the added benefit of potential savings in reduced malpractice claims. Being honest with patients builds trust and strengthens the relationship between patients and providers. "[Malpractice challenges] are never going to get better until we embrace the notion that all parties — patients, families and caregivers — are in this together," Mr. Boothman says.
More Articles on Healthcare Transparency and Quality:
5 Must-Haves for a Hospital Patient Safety Program
Dr. Toby Cosgrove: Transparency in Healthcare is "The Right Thing to Do"
Responding to Physician Rating Sites With Transparent Patient Satisfaction Data
4 Tips to Implement a Transparent Medical Error Disclosure Policy
Ann Arbor-based University of Michigan Health System has been widely recognized for its innovative medical error disclosure policy called the Michigan Model. In the case of an error or complaint, a team of professionals analyzes the situation to determine the cause of an event. If the team determines there was a medical error or care was inappropriate, the providers apologize and work with the patient to reach a joint solution. If the team determines care was medically appropriate, UMHS explains the case to the patient and defends its providers.
Since UMHS began this approach in 2001, the number of pre-suit claims and pending lawsuits dropped approximately 61.5 percent. In addition, UMHS decreased its average legal expense per case by more than 50 percent since 1997, including a savings of $2 million in the first year alone of the Michigan Model.
What disclosure is really about: Safe patient care
While these results are impressive, the true value of the program is in higher quality and safer care, according to Rick Boothman, JD, chief risk officer of UMHS. "It is important to understand that our approach is not just about achieving savings in claims; at the heart of our approach is a deep commitment to learning from our mistakes and improving the quality of our care," he says. "Transparency is not just a strategy for handling claims. The core value of transparency is that it is absolutely necessary if we're going to improve the quality of medical care."
Replicating the Michigan Model
Here are some tips to implement a transparent medical error disclosure policy in a hospital or health system.
1. Communicate the benefit to providers. Being honest with patients about medical complications, whether due to a provider error or not, benefits both patients and providers. When a mistake is made, being honest with a patient enables providers to learn from their error. When providers did not make a mistake, acknowledging this fact instills confidence in them.
Being honest with patients can also save providers from needless litigation — an outcome opposite of many people's expectations, according to Mr. Boothman. "We didn't open a floodgate of claims by admitting we've had our own share of problems," he says.
2. Designate a physician advocate. Hospitals should designate a leader in the risk management department to be a physician advocate to encourage openness. "I have never advertised myself as a patient's advocate," Mr. Boothman says. "I know what I'm doing directly benefits patient care and patients, but it's important for me to say to staff, 'I 'm here for you.'" Having someone to support providers through the disclosure process is critical for building trust with providers and encouraging openness.
3. Ease others' fears. One of the biggest challenges to implementing a transparent disclosure policy is resistance from people who feel their job is threatened by a new approach to medical errors and malpractice, according to Mr. Boothman. Hospitals' defense lawyers are typically the most resistant to this change, possibly because they believe their job may not fit in the new model, he says. "The industry, which has been built around a deny-and-defend mentality, is very threatened by this. But if our heart is in the right place and we want to do the right thing by our clients — doctors and hospitals — [the transparent approach] makes too much sense," he says.
4. Consider the role of insurance. UMHS is self-insured for malpractice insurance, which, while not a requirement for its disclosure model, does make the policy easier to implement, according to Mr. Boothman. First, being self-insured guarantees that the malpractice claims policy aligns with a goal of quality care. "An independent insurance company does not have the same interest that a self-insured institution like ours would have in terms of an abiding interest in quality of care," Mr. Boothman says. In addition, being self-insured eliminates the challenges associated with working with an outside company. "We don't have another corporate voice to deal with," he says.
Committing to medical error transparency
Ultimately, committing to transparency with medical complications and errors is critical to improving quality and patient safety, and has the added benefit of potential savings in reduced malpractice claims. Being honest with patients builds trust and strengthens the relationship between patients and providers. "[Malpractice challenges] are never going to get better until we embrace the notion that all parties — patients, families and caregivers — are in this together," Mr. Boothman says.
More Articles on Healthcare Transparency and Quality:
5 Must-Haves for a Hospital Patient Safety Program https://www.beckershospitalreview.com/quality/5-must-haves-for-a-hospital-patient-safety-program.html
Dr. Toby Cosgrove: Transparency in Healthcare is 'The Right Thing to Do'
https://www.beckershospitalreview.com/quality/dr-toby-cosgrove-transparency-in-healthcare-is-qthe-right-thing-to-doq.html
Responding to Physician Rating Sites With Transparent Patient Satisfaction Data
https://www.beckershospitalreview.com/quality/responding-to-physician-rating-sites-with-transparent-patient-satisfaction-data.html