| Today's hospital administrator faces a number of | | | | "high-complaint" physicians; meaning in a survey of |
| challenges including rising costs, labor shortages, | | | | physicians in one teaching hospital they had the most |
| increased regulatory requirements and the potential | | | | patient complaints on file. Complaints fell into |
| for costly, credibility damaging lawsuits. We live in a | | | | categories of communication, care and treatment, |
| litigious time. Disputes are played out in the court | | | | humaneness, access, environment, and billing. |
| system and in the realm of health care, lawsuits can | | | | Physicians who have a bad rapport with their patients |
| take millions of dollars and years before they are | | | | had a higher incidence of every other type of |
| concluded. It is in the best interest of hospitals to do | | | | complaint listed. In other words, patients were more |
| all that is possible to mitigate the risk of litigation. | | | | likely to report adverse outcomes or diagnosis |
| Every hospital will face litigation but there are ways | | | | problems when the physician was considered rude or |
| to reduce the opportunity and /or reduce the | | | | communicated poorly. |
| damages if sued. While in no way a comprehensive | | | | Quality management. Quality programs must be more |
| list, the following guidelines can help. | | | | than the program du jour. Just as risk management |
| Risk management must be facility wide. All Hospitals | | | | must be embedded in the hospital culture, there must |
| have Risk Management Departments but risk | | | | be a bottom up commitment to quality procedures. |
| management cannot be confined to a department to | | | | Quality when viewed through the lens of "must do" |
| be truly effective. It is not enough to satisfy the | | | | policies and procedures becomes devalued as "one |
| requirements of the various governing bodies during | | | | more management program." However, an |
| times of accreditation. An effective risk management | | | | organization that involves everyone in the quest for |
| program is embedded into the culture of the hospital. | | | | quality and the pride that accompanies providing an |
| Every employee at every level is in effect a risk | | | | excellent product or service will be far more |
| manager. Risk management is sometimes viewed as | | | | effective. |
| a necessary evil. Hospitals must move beyond doing | | | | Infection Control. In the United States more than 1.7 |
| what is required to adopting a risk adverse culture. | | | | million people will get a drug resistant infection from a |
| This requires active involvement of staff at all levels, | | | | hospital. More people die from hospital infections than |
| continuous monitoring and communication. | | | | AIDS and breast cancer combined. Hospital acquired |
| Internal Service. Employees that do not feel valued | | | | infections is a well documented problem and |
| by the organization will not invest in its policies. | | | | disturbingly most can be prevented through the |
| Studies have shown that employee satisfaction leads | | | | implementation of rigorous sanitary and bacterial |
| to greater productivity and loyalty. Hospitals must | | | | testing procedures. Infection control needs to be |
| make everyone feel like part of the team, physicians, | | | | vigorously monitored and should be a vital piece of |
| nurses, clerical, every person that works in the | | | | the overall risk management strategy. |
| hospital must feel like an integral part of the | | | | Any risk mitigation strategy will require an organized, |
| healthcare team. In no other environment is | | | | rigorous surveillance and management to be |
| teamwork a life and death matter. More importantly, | | | | effective. Physicians, and hospital staff all play a part |
| happy employees treat patients well. Patients that | | | | in risk management activities but hospital |
| have a positive hospital experience even in the event | | | | management must make decisions and provide |
| of a problem are more willing to resolve the dispute | | | | sufficient resources for risk management activities. |
| without litigation. It is human nature to not wage a | | | | Staff and physicians should have an active voice in |
| hostile battle with someone who has treated you | | | | policy and risk events need to be clearly |
| well. Treat your staff well and make them feel | | | | communicated to all. As risk is identified there also |
| valued and patients will receive better care and you | | | | needs to be a clear mechanism for correcting or |
| will lower your risk of litigation. | | | | eliminating the risk. The absence of problem-resolution |
| Doctor-Patient Relationship. There is a great deal of | | | | mechanisms in hospitals is a major cause of poor |
| evidence to support the importance of the impact of | | | | quality and unnecessary risk. |
| the doctor-patient relationship on litigation. This | | | | Managing risk will not only reduce the potential for |
| relationship is a significant determinant of the | | | | litigation but will provide hospitals with a clear |
| physician's claims experience (Hickson et al., 1997; | | | | competitive advantage. A hospital that adopts a risk |
| Levinson et al., 1997; Pontes and Pontes, 1997; | | | | adverse culture will provide better patient care and |
| Beckman et al., 1994) Hickson et al. found that | | | | that translates to success in the highly competitive |
| "high-malpractice" physicians were also likely to be | | | | marketplace of healthcare. |