Health information system electronic health record week 2

Chapter 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