The medical liability experts at MMIC describe how practices can reduce the risk of patient injury and malpractice claims by improving the diagnostic process and helping patients become engaged and confident in their relationships with their physician.
The stereotype of fighting against malpractice claims is that it is an antagonistic process: patient versus provider. However, the true battle is to keep patients safe from injury and prevent claims in the first place. It is in that space that MMIC excels.
At MMIC, patient safety consultants and analytics experts work together to:
- Focus on problem areas in healthcare delivery where malpractice claims are likely to occur
- Identify trends and contributing factors that give rise to disproportionate numbers of claims
- Educate policyholders, from solo-practice physicians to large healthcare systems, on how to evaluate and enhance care processes so they don’t result in patient harm
A key element in this process involves the work of Lori Atkinson, RN, BSN, CPHRM, CPPS, Manager, Research and Education with MMIC Patient Safety Customer Solutions, and Trish Lugtu, BS, CPHIMS, Senior Manager, Advanced Analytics Solutions with MMIC, who work together to marry the “art” and “science” of data analytics, helping their clients mitigate risk and improve patient safety.
Knowing the Numbers
Data is Lugtu’s business — the “science” component of risk management. In seeking ways to both understand a problem case and prevent similar circumstances in the future, she examines relevant claims data, drawing on both MMIC’s population of cases and national benchmarks. An objective analytical reading of the pertinent claims documents is the first step.
“Clinical coders classify our malpractice claim files objectively using a taxonomy specific to medical professional liability claims,” Lugtu says. “This allows us to perform statistical analysis across our claims. We start with what we know, such as issues in clinical processes or allegations in particular settings or specialties. And through that focused lens, we look for the causal factors that occur with significant frequency.”
Part of the analysis process includes comparing the findings to national benchmarks. MMIC’s partnership with CRICO Strategies is integral to this process. CRICO Strategies — a division of the Harvard Medical Institutions’ Risk Management Foundation — researches patient safety and risk management and offers the Comparative Benchmarking System (CBS) that includes more than 400,000 cases representing 30 percent of national malpractice claims.
“CRICO convenes a collaboration of commercial and captive insurers, academic medical centers, hospitals, and health systems through CBS,” Lugtu says. “As a member, we are able to benchmark our claims with peers across the company. It’s a valuable tool for helping us identify occurrences that fall outside of what we would normally expect.”
Any departure from a rate of incidence indicates a warning signal that warrants closer inspection, she explains. Lugtu and her colleagues leverage benchmarking statistics and five-year trends to direct focus then further collaborate with subject matter experts to understand and describe exactly what’s happening. The process combines computer analysis with human insight — hybrid insights fueled by algorithms and personal judgment.
“We build context from previous research studies; for instance, we might look at the diagnostic process as described through medical journals and adopted by various medical organizations,” Lugtu says. “We take that knowledge and cross-reference with our claims data to highlight scenarios to delve into more specifically.”
Once those scenarios are isolated, patient safety and risk management experts develop actionable solutions.
Telling the Stories
The healthcare industry produces more data than a single person is capable of processing. To make use of that data, that’s where “art” comes into play. It takes keen insight to identify key questions, select instructive moments, and translate these instances into words that move listeners or readers to change their behavior, creating positive shifts in clinical outcomes.
Error can be difficult to talk about, bringing about the suggestion of accusation and wrongdoing. However, Atkinson says, when an adverse outcome results in a malpractice claim, the problem is often a matter of a system failure or a communication breakdown, something that may occur early in the diagnostic process.
“We use our data to identify breakdowns in care processes, and we examine case studies to find meaningful insights — to illustrate the data in a human way,” Atkinson says. “When we can tell stories about what happened to a patient or a physician, it gives a human face to performance improvement in health care.”
Stories can be motivational, inspiring an urge to be like the protagonists or, of course, to avoid the situations the protagonists find themselves in. Stories also illustrate the how behind why something happened, showing steps along the way to a problem. In that way, they also point readers or listeners toward alternative paths that could have been taken to reach more optimal endings.
“I’ll read the case abstracts to see the details,” Atkinson says. “The coders give us several paragraphs of information on the case, and I study that to dig deeper and see what happened. I look at medical records, expert reviews — any kind of investigation into what went wrong. From there I can say, ‘Here is the problem and the process that led to the problem and here are the recommendations to strengthen the process.’ That’s how I fill in the gaps, raise awareness about what happened and craft a solution.”
Creating Positive Change
After MMIC’s experts have achieved a data-informed understanding of a problem and transformed it into a useful narrative, the next step is to get that narrative in front of the people who can use it — physicians, nurses and healthcare administrators. MMIC does this through round tables, speaking events and private collaborations. Best practices and guidance are available on MMIC’s website, too. Brink magazine, downloadable from mmicgroup.com/resources/stay-informed, helps healthcare leaders stay up to date with the latest data-driven insights from MMIC.
MMIC patient safety and risk management consultants work with policyholders to provide guidance, Atkinson says. That interaction may take place as a webinar open to many participants or as a deep delve for a single practice.
“They work with policyholders to look at diagnostic processes and give them best-practice guidance,” Atkinson says. “They also give large presentations on current issues such as opioid prescriptions and treating chronic pain. They educate policyholders, explain the data, identify gaps in practice and show physicians how they can assess their own practices and discern what strategies to implement to minimize risk.”
“We decide what educational sessions to offer by looking at the trending issues,” Lugtu adds. “We use data to inform as much as we can. We do analyses to support new education programs, research arising issues and to generally inform our topics and areas of focus. We also leverage our data to develop specialty claim profiles to empower our consultants with risk hotspots when they visit our policyholders.”
Examples of processes that may warrant improvement include:
- Follow-up to cancer diagnosis in primary care
- Informed consent in surgical specialties
- Opioid risk during pain management treatment
Many malpractice hotspots involve barriers to clear communication, whether between patient and provider or among the patient’s care team.
“We sift through the information and point out the big things so that physicians can focus and prioritize their improvement processes,” Atkinson says. “For example, communication is a key issue in all kinds of claims, across all areas. If you are not listening to a patient’s story or taking careful note of their symptoms and the course of the illness as they describe it, you may miss something you could put into your clinical decision algorithm to help you rule in or rule out a potentially serious condition.”
“In any situation involving communication, people will more likely engage if they feel safe,” Lugtu concurs. “In the physician’s office, the power differential can be especially daunting, and it is up to the physician in the position of authority to engage the patient in care delivery. Without addressing communication as a skill, physicians can be missing opportunities for more effective interactions with their patients.”
Communication factors into building trust and patient engagement, key pieces of risk avoidance.
“We try to promote a team-based care philosophy — one that includes the patient and family,” Atkinson says. “Part of the art of the team is making sure communication goes both ways. The patient listens to the physician, and the physician listens to the patient’s story. They share decision-making as to the course of treatment and its risks versus the risks of alternative treatments or no treatment. Patients are more likely to become engaged and follow advice when they are part of the team, understand the situation, and feel their clinicians are listening to them and providing the best advice based on their circumstances.”
Other times, the communication issue may lie simply in relaying a message.
“Follow-up can be a problem,” Lugtu says. “When we performed our analysis on the diagnostic process, we found that 42 percent of the diagnosis-related outpatient claims involved breakdowns after a diagnosis was made — when the diagnosis was not communicated to the physician or patient, or follow-up and referral coordination was lacking. The diagnosis itself may have been accurate, but diagnostic error still occurred because support systems didn’t work, and they were ultimately unable to carry out the next necessary steps to successfully act upon diagnosis.”
This kind of teachable moment, Lugtu says, is an especially important insight for healthcare executives to process. The entire team, including the people responsible for care coordination and referral, may need to modify its procedures to enable effective communication throughout diagnosis, treatment and recovery.
“When we use data to pinpoint process breakdowns, those are areas we can expand upon with healthcare executives specifically,” Lugtu says.
MMIC experts realize that physicians are busy; they help physicians, risk managers and administrators focus on the risks most impactful to them and their patients.
“It’s impossible to remove all risk, so you work toward minimizing the important ones,” Lugtu says. “And improving those processes will cascade to other lesser risk areas, as well.”
“Our data can help point the way, but healthcare organizations need to look at their own processes and system to identify vulnerabilities,” Atkinson says. “At MMIC, we can help them do just that.”
To learn more about MMIC’s unique approach to risk assessment and mitigation, visit mmicgroup.com.