Health Care Risk Management
Helpm31990
Chapter4.pptxChapter 4: Communications to Reduce Risk
Communication is a risk?
Lack of communication between physicians and their patients can be a critical factor leading to malpractice lawsuits
Lack of communication can lead to patient dissatisfaction
Dissatisfied patients are more likely to pursue malpractice litigation
Barriers to Communication
Lack of or poor listening skills
Physical barriers
Personal distractions
Communication depends on…
Personality
Age
Environmental factors
Income
Education
Social situation
Intelligence
Fluid intelligence
Crystallized intelligence
Communication and Risk Management
Understanding patients within their societal environment and culture is important to managing risk
This will assist with communicating to the patient at their level of understanding
Misunderstandings due to cultural or societal differences may be avoided with attention to proper communication
Why do Patients Sue?
Patients tend to sue when the Provider has caused them harm but also when they feel the Provider has:
Deserted them
Didn’t listen or devalued their view
Didn’t give them necessary information or didn’t explain it
Didn’t understand or acknowledge their perspective
Why is this important?
Patients do not have the skills to accurately identify ‘quality’ healthcare, therefore they tend to view how they are treated (customer service) as an indicator of quality of care
Poor customer service = Poor quality
What are Patients looking for with litigation?
Altruism
Rationalization
Recompense
Accountability
Do unto others…
Respect and civility can play a major role in risk management. Providers need to civil and respectful of their patients’ concerns by offering:
Empathy
Compassion
Care
Cultural Awareness
Providers need to have an understanding (sensitivity) of their patients’ backgrounds as cultural differences can lead to misunderstandings or non-compliance if not properly attended to.
Cultural destructiveness
Cultural incapacity
Cultural blindness
Patient Empowerment
Studies show that much patient dissatisfaction comes from deficient communication
Empowering the patient to be an active participant in the provision of healthcare may lead to improved communication
Programs are available to assist the patient in learning their role in provision of health
TJC: Speak Up program
AHA: Patient’s Bill of Rights
Facility specific: Complaint/Grievance Process
Health Literacy
Degree to which individuals have the capacity to obtain, process and understand basic health information.
Approximately 1/3 of adults have basic or below basic skills for dealing with health material
Health facilities must follow federal regulation to provide language services for those patients with limited English proficiency (LEP)
Informed Consent
Informed Consent implies that the patient understands the service to be rendered, the risks involved and potential outcomes.
Valid consent is given when the patient:
Has been informed
Is competent
Has not been coerced
Why do risk managers care about informed consent?
Courts have decided that patients have a right to control their own body and decide about medical treatment
An informed and educated patient is more likely to have realistic expectations about his condition/treatment
Patient Education
Poor communication can increase patient non-compliance which can lead to harm
Adherence to physician instructions can be improved with communication:
Agree upon diagnosis through discussion
Simplify regimen
Written instructions in understandable language
Motivate the patient to adhere to instructions
Discuss potential risks, side effects and costs
Barriers to Patient Education
Lack of time
Health literacy of the patient
Fear of materials being used against the provider
Skepticism of patient’s ability to follow instructions
Lack of adequate reimbursement
Effects on the provider’s personal life
Difference of Opinion
Due to their level of health literacy, patients and providers may see potential side effects or adverse reactions quite differently
Provider sees an anticipated outcome
Patient sees an error
Physicians also have a different take on errors and tend to define them more narrowly
Disclosure
Disclosure can show that the provider is not hiding anything and may serve to
Lessen the tendency to litigate
Increase the tendency to settle
Patients desire full disclosure of harmful errors
An acknowledgement that the error occurred
What happened
Why it happened
Implication to patient’s health
How it will be avoided in future
An apology
Apologize
If something has gone wrong, the patient has the right to an apology.
Unfortunately, many providers are cautious to do so due to concern an apology would be an admission of guilt or wrong doing
Some states have enacted Apology laws which make physician apology inadmissible in court
Disclosure, explanation and apology should come within a reasonable timeframe of the incident.
Key Issue – Patient Satisfaction
Patients who are satisfied are less likely to sue
It has been found that anger, not injury is the trigger for most malpractice claims.
Studies suggest that empathy and good interpersonal skills may decrease the likelihood of malpractice claims
Consumer Information
With advent of the Internet and Social Media, healthcare consumers have access to multitudes of information not only on healthcare topics, but on their healthcare providers as well
CMS website offers comparison of healthcare facilities based on reported quality indicators
Accreditation also gives consumers information regarding their health facility providers
Issues with Web-based Information
Consumer self-rating information is also available on the web though it is not vetted
Social Media opens issues with confidentiality
Courts have yet to set precedents regarding use of Social Media
Summary
Appropriate and Positive Communication is a valuable Risk Management Tool as it can have an impact on patient satisfaction
Dissatisfied patients are more likely to sue even if there is no injury
Satisfied patients with an adverse event are less likely to sue
