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Not “Just” an EmployeeHow medical office staff can help prevent malpractice lawsuits
MGMA Annual ConferenceOctober 2013
Pamela Willis, BSN, JD, RNPatient Safety/Risk Management Account Executive
Presentation Goals
• Understand liability exposure in the medical office
• Recognize the role of office staff in helping prevent malpractice claims
• Identify communication issues that present an opportunity to improve quality of care
• Review communication and documentation strategies that will decrease your risks
• Discuss examples of systemic breakdownthat are factors in malpractice claims
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I’m Just an Employee…
Isn’t malpractice all about
the doctor?
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Understand Your Role...
You make a difference... The physician’s office staff is
the first line of defense against a medical malpractice lawsuit.
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How Do Patients Measure Quality of Care?
Rapport with providers...
Patients lack medical knowledge so they use the quality of interaction as a means to define the qualityof their medical care
Did I get what I expected? Did I get better? Did they care about me? Did the physician and staff
project confidence?
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Why Do Patients Sue Their Doctor?
• Anger• Dissatisfaction with treatment• Want answers but no one will talk• Unhappy with staff or provider attitude• Revenge or retaliation• Entitlement attitude
Communication is a factor in all of these reasons!
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Closed Claim Data 2007-2012
* Communication is rarely the only issue; cases are influenced by other factors including severity of injury.
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Where Communication Breaks Down
Key information is unknown or not passed along Fax or phone messages Physician to physician Staff to physician Physician to staff Physician/staff to patient/family*
*Communication breakdown with the patient or family is the most common failed communication area seen in our closed claims.
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Communication Statistics
Miscommunication can lead to poor patient outcomes, misunderstandings, and lawsuits.
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How Can Staff Help?
• Avoid yes/no questions Do you understand? Do you have any questions?
• Repetition of information • Provide written instructions• Teach back• Do not allow patient to sign a consent form if he or
she still has questions for the provider• You have a direct influence on patient satisfaction
Patient satisfaction is directly related to the filing of a suit* *Return-on-Investment: Reducing Malpractice Claims by Improving Patient Satisfaction.
White Paper: Press Ganey Associates, Inc. 2008
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Barriers To Effective Communication
• Patient anxiety• Illness/pain/fatigue• Multiple questions/instructions at once
“TMI”
• Culture• Literacy• Health literacy: patient
understanding of health-related issues
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First Impressions
Each interaction with a patient, whether over the phone or in person, is an opportunity to create an impression for the practice.
Will it be positive or negative Critical to establishing good patient rapport
Tips: Greet everyone who enters Courteous and professional phone etiquette Assign waiting room hospitality
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No One Likes to Wait…
The waiting room and patient rapport• Monitor wait times
Notify patients of an unexpected long wait Offer rescheduling or run errand and return
Studies reveal that those waiting are less impatient if the environment is comfortable.
Provide a variety of current reading materials Maintain comfortable temperatures Ensure the seating arrangement is comfortable Provide water/beverages if possible Be alert to disruptive behaviors in the waiting room
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Patient Satisfaction
• Study after study has found a correlation between patient satisfaction and the filing of lawsuits.
For example:• When splitting satisfaction surveys into three groups,
one study* found:– Providers with the most satisfied patients had the least
amount of malpractice suits– The middle group of providers had 26% more suits– Providers with the least satisfied patients had 110%
more suits!
* Stelfox, H.T., et al. 2005. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. American Journal of Medicine. 118:126-33.
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Staff Telephone Communication Tips
• Answer the phone promptly• Be courteous and professional• Always ask before putting someone on hold• Identify yourself and give your title• Document all calls and follow-up actions• Refer calls to the appropriate
staff person with a warm handoff• Return messages promptly
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Telephone Advice
Do not allow medical advice to be given by unlicensed staff members.
• Give only information commensurate with your scope of practice
• Courts will look at: Training, education, and licensure Documentation of the call Harm to the patient
• Establish written protocols to guide responses to common patient questions
• Ensure provider availability when needed
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The Challenging Patient
The complaining, demanding patient wants to:• Be taken seriously• Be treated with respect• Be listened to and heard• Have the problem acknowledged• Have someone take action• Be assured the problem
will not recur
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Apologize for the Situation
“I’m sorry you are going
through this…it must be
very frustrating for you.”
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Handling Challenging Patients
• Take a deep breath and a moment to collect yourself• Don’t get sucked into an argument• Separate the hostile person from others• Use a confident, calm tone of voice• Listen to and acknowledge concerns• Clarify expectations and financial obligations• If you do not know the answer, promise follow-up
and then make sure to do so!• Always alert the provider to the situation
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The Challenging Patient
Decrease your liability in dealing with challenging patient situations…• Give patients the answers they request• Don’t hide from disgruntled patients• Try to understand and empathize • Don’t take things personally• Allow the person to vent• Consult with your risk manager on how to handle
disclosure of an error
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“Your most unhappy customers
are your greatest
source of learning”
Bill Gates
Business @ The Speed of Thought
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Top Reasons for Lawsuits in the Office
Missed diagnosis and delayed diagnosis
• Test/procedure/consult results must be meticulously tracked to avoid this pitfall
• You order it, you own it! Track tests/procedures/consults until results are received Notify patients of all resultseven normal Document that notification has occurred Assure that recommended follow-up occurs
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Test Result Tracking
• Clarify with patients how results will be reported Responsibility cannot be shifted to the patient
• Use a manual tracking log or EMR tickler file and log every step:1) The test is ordered
2) The result is received
3) The provider signs off on the result
4) Follow-up instructions are received from provider
5) The result is reported to the patient
6) Follow-up is facilitated and carried out
7) Any breakdown in the chain is documented!
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Documentation
• The medical record is a legal document• Evidence of the good care you give• Communicates to others on the patient care team• Demonstrates the outcome of care
Tips Staff should chart what they see and hear, not what they think Be careful of EMR auto-fill features Label late entries as such Periodically review a printed copy of an EMR chart
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More Tips…
• Create a safe environment where patients feel comfortable asking questions
• Use plain language instead of medical jargon • Sit down to achieve eye level with your patient • Use complaints as an opportunity to improve• Go the extra mile to establish a rapport• Utilize patient satisfaction surveys!
Share results with staff and troubleshoot for improvement
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• Recognize that as office staff you are the first lineof defense against malpractice liability
• Understand your role in enhancing thepatient experience and building rapport
• Be the office that truly cares about its patients• You can make a difference every day!
Remember…
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Complimentary Resources…
For additional Patient Safety information, please visitwww.thedoctors.com
(800) 421-2368, ext. 1716
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Our mission is to advance, protect, and reward the
practice of good medicine.
