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Background
Studies of medical malpractice show that:
- Approximately 1-6% of hospitalized patients experience unexpected adverse outcomes1,2
- Approximately one third of these adverse outcomes are associated with medical negligence1,2
- Approximately 2% of patients injured through medical negligence sue1,2
- About 5 times more patients sue despite seeming lack of medically valid claims1,2
- Some doctors attract a disproportionate share of malpractice suits3
- High malpractice risk today predicts high risk tomorrow4
- Non-economic factors motivate patients to sue5
- Important predictors of claims filed per doctor are patient/family perceptions of doctor interest, accessibility and communication skills; RVU (relative value unit) production; field of practice; maybe gender; technical quality of care is less predictive6
- Patient complaints predict physicians’ risk management activity7
Aggregated patient complaints about their care serve as warnings about doctors at increased risk of generating malpractice-related activity. Therefore, we now systematically identify physicians and service units with the greatest rates of patient dissatisfaction at Vanderbilt University Medical Center and a number of other institutions. The goal is to reduce patient dissatisfaction and adverse financial outcomes through interventions which improve the (perceived) quality of care.
What We Do
- Our Patient Advocacy Reporting System (PARS®) codes for 6 complaint types, 35 subtypes. Coders demonstrate high inter-coder reliability for complaint type, person complained about and location in the medical center associated with the complaint.8,9
- Use computer software designed to assist Patient Affairs Office representatives. We offer our own Patient Affairs Complaint Tracking® (PACT) database system for this purpose or we are often able to use a medical center’s existing database(s).
- Code complaint reports from medical centers’ Patient Affairs (Sometimes called Patient Relations or Patient Advocates) Offices involving thousands of specific complaints.
- Coders also identify the person allegedly responsible for each complaint.
What We've Learned
High Complaint Physicians are associated with:
-
Half of all patient complaints associated with physician
-
More than 40% of Risk Management file openings and posted indemnity reserves
-
50-60% of dollars paid out in costs, settlements and awards
- More high dollar cases
Where We Go From There
A 'patient complaint profile' is created for each physician in the top 6-8% of complaint generators; it depicts each physician's complaint score relative to other group members. Data tables show physicians what types of complaints stand out.
- Patient Complaint Monitoring Committees composed of physician peers are established at each medical center consistent with its own policies and procedures and the laws of the state in which it resides.
- The VUMC policy is available to serve as a model for the committee.
- Members of these Patient Complaint Monitoring Committees are trained how to share sensitive information with high complaint colleagues.
- Committee Members use the profiles as the basis for intervention.
- The Committee tracks patient complaints (and, in some cases, risk management outcomes) over time.
Confidentiality, supportive attitudes, and professional behavior must be strictly maintained.
To inquire about adopting PARS® in your institution, please contact Dr. Hickson (Gerald.Hickson@Vanderbilt.edu) or Keith Rawlings (Keith.Rawlings@Vanderbilt.edu).
Citations
1. California Medical Association and California Hospital Association. Report of the Medical Insurance Feasibility Study. San Francisco, CA: Sutter Publications, 1977
2. Brennan TA, Leape LL, Laird N, et al. Incidence of adverse events and negligence in hospitalized patients: Results of the Harvard Medical Practice Study. NEJM 1991;324:370-376.
3. Hickson GB, Gentile DA, Githens PB, Sloan FA. Liability, In: Suing for Medical Malpractice, Chicago: University of Chicago Press, 92‑122, 1993.
4. Sloan FA, Mergenhagen PM, Burfield B, Bovbjerg RR, Hassan M. Medical malpractice experience of physicians: Predictable or haphazard? JAMA, 262:3291‑3297, 1989.
5. Hickson GB, Clayton EW, Githens PB, Sloan FA. Factors that prompted families to file medical malpractice claims following perinatal injuries. JAMA, 267:1359‑1363, 1992. [abstract]
6. Hickson GB, Clayton EW, Miller CS, Githens PB, Whetten-Goldstein K, Entman SS, Sloan FA. Obstetricians' prior malpractice experience and patients' satisfaction with care. JAMA 272:1583-1587, 1994. [abstract]
7. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. JAMA;287:2951-2957, 2002. [abstract]
8. Hickson GB, Pichert JW, Federspiel CF, Clayton EW. Development of an early identification and response model of malpractice prevention. Law and Contemporary Problems, 60 (1): 7-29, 1997. [article]
9. Pichert JW, Federspiel CF, Hickson GB, Miller CS, Gauld-Jaeger J, Gray C. Identifying medical center units with disproportionate shares of patient complaints. Joint Commission Journal on Quality Improvement, 25(6):288-299, 1999. [abstract]
10. Eisenberg, JM. Doctors' decisions and the cost of medical care: The reasons for doctors' practice patterns and ways to change them. Ann Arbor: Health Administration Press, 1986.
