Why Risk Management?

Patient safety and risk avoidance include the identification, analysis, control, and prevention of risks that could harm a patient’s care. Effective risk prevention will improve the quality of patient care and reduce the frequency and severity of malpractice claims.

This overview contains three sections that discuss why patients sue and how you, as a participant in patient care, can effectively reduce the risk of harm to a patient and develop rapport through the art of effective observation and communication.

Why Patients Sue

Patients sue for many reasons. Any patient has the potential to sue with sufficient motivation. Some of the most common reasons include:

• dissatisfaction with the results of treatment,
• patient/family anger,
• unrealistic patient expectations,
• poor communication skills of patient/
• provider/office personnel,
• a poor attitude on the part of patient/
• provider/office personnel;
• financial incentives, and
• criticism of previous care.

These reasons have one thing in common. They all result, to some extent, from poor observation and/or communication. Your ability to communicate could prevent harm to a patient or critically affect patient satisfaction should a harmful event occur. Patients often define good care by how comfortable and welcome they feel.

Tips

• Remember that you are providing a service: Always be courteous, and maintain your professionalism.
• Be respectful of patients: Identify them by name.
• Try not to react defensively even if the patient is behaving in a negative manner.
• Be a good listener: Sometimes all the patient wants is to have someone listen to his or her concerns.
• Be observant of body language.
• Be observant of patient and family interactions. Notify your office manager or the physician of patient complaints.

How to Keep Patients Safe and Avoid Malpractice Suits by Identifying Risks

Understanding risk and controlling it are critical to patient safety. Each of us has been avoiding risks since childhood. When a mother takes the hand of a child when crossing the street, she is practicing risk avoidance. Brushing your teeth and flossing every day are practicing risk avoidance. Risk avoidance is not difficult in the healthcare setting, but it requires careful thought, observation, and planning.

Sources of risk exposure in a physician’s office can be either direct or indirect. An example of a direct risk is failure to document a patient’s allergy to a medication. By failing to document the allergy, the patient could be harmed if he or she is given the medication. An example of an indirect risk is a chair with wheels in the exam room. If a child or an unstable adult attempts to sit in the chair, he or she could fall and be injured.

Injury to patients is the primary cause of litigation. Good patient care requires that patients be kept safe. Harm to patients can be prevented. When a potential risk is identified, there are two steps that should be taken to ensure patient safety. First, the cause of a potential injury must be removed immediately, and second, notify your supervisor or the physician so that permanent steps can be taken to avoid a recurrence of the risk. If every risk of injury is approached in this manner, a large number of patient injuries will be prevented.

Patients can be injured in a variety of ways. Examples include unsafe facility conditions, unsafe practices, and inadequate documentation in the patient’s record, inappropriate comments to the patient or family, failure to report incidents when they occur, and breach of patient confidentiality. Even when such conduct does not constitute a direct danger to patients, it increases liability and warrants a thorough evaluation and, in some cases, a change in policy.

Providing a safe, secure environment pertains to both the patient’s physical and mental well being. Patients need to know that they are in good hands, that their confidentiality and privacy will be maintained, and that they will receive the best possible care.

We have a duty to our patients to provide them with a safe environment.

Tips

• Do a walk-through of the facilities to look for possible risk conditions. Many adverse events can be prevented by careful observation.
• Ensure that rugs and furniture are stable.
• Make sure that all foot traffic areas are open with no obstructions.
• Check and calibrate all new equipment prior to use.
• Remove all malfunctioning equipment from service and test before reuse.
• Identify all exits and keep them unobstructed.

We have a duty to provide quality medical care and to meet the needs of our patients.

Tips

• Document important patient information.
• Notify healthcare providers of patients’ questions concerning their healthcare.
• Provide patient education materials when appropriate.
• Notify others when the patient or family expresses dissatisfaction.
• Listen to the patient, and show interest in what he or she has to say.
• Complete an incident report when appropriate, and enlist the aid of your supervisor or risk management personnel.

How to Avoid Malpractice by Using Effective Communication

The importance of effective communication cannot be overstated. The most common reason for patient dissatisfaction is failed communication. Faulty communication often leads to the inevitable vicious cycle of: 1) disappointment, anger, or patient frustration; 2) reactive hostility, defensiveness, and arrogance by the healthcare provider or office staff; 3) deepening patient anger; and 4) ultimately, the patient’s visit to an attorney.

The office staff is often the first to know that a problem exists. In many cases, the patient spends more time with the office staff than with the physician. Many times a patient is reluctant to talk to the physician directly about his or her feelings and concerns. A patient will often discuss and/or vent his or her feelings and concerns to the office staff. It is not always the words that the patient says that may tip you off to a problem. Many times body language or the things the patient does not say reveal anxiety, fear, and pain.

Examples of body language include:

• If the patient is standing or sitting far away from you, he or she may be distrustful.
• If the patient is standing or sitting with crossed arms and legs, he or she may be indicating a general mistrust.
• If the patient’s color is pale, he or she may be fearful or experiencing pain.
• If his or her face is red, he or she might be angry or upset.
• If the patient has pursed lips, he or she might disagree with what you are saying.
• If he or she is frowning, it could indicate concern or worry.
• If he or she is perspiring, it could be an indication of the room temperature, nervousness, or pain.

Communication breaks down into the following:

• 60 percent is body language,
• 30 percent is the delivery, and
• 10 percent is what we say/the words we choose.

Developing good rapport is essential to effective communication. First impressions, which normally occur within the first four minutes of an interaction, can set the tone for the entire interaction. Calling the patient by his or her first name doesn’t always put the patient at ease. Some patients resent familiarity. It is important to be sensitive to the patient’s preference and to always treat the patient with respect. Effective communication requires attention, patience, and response.

Be a good listener. Hearing and listening are extremely dissimilar processes. Unlike hearing, which is the perception of physical stimuli to our ears, listening is the active, cognitive process of interpreting what we hear, evaluating the information, and deciding how that information may be used. Many times you will learn information through casual conversation that the patient will not otherwise volunteer.

Be an active listener. Active communication is a two-way, give-and-take process. Maintain eye contact, and try not to interrupt when the patient is speaking. Be sure that you understand what the patient is trying to convey. One way to be sure that you understand is to repeat back to the patient what he or she has said. This will help to clear up any misconceptions or misunderstandings and show that you are paying attention. The physicians’ office environment permits interruptions that make it difficult to listen effectively. If possible, do not allow distractions, such as a ringing telephone, to steal attention when communicating with a patient.

People are reluctant to sue someone they like, and they tend to like people who demonstrate interest by listening and talking with them. Therefore, the practice of being a good listener can be a powerful patient safety and claims-prevention tool.

Tips

• Remember, the first four minutes of an interaction set the impression.
• Avoid excessive familiarity.
• Be warm, friendly, and caring. Make each patient feel welcome and important.
• Watch for body language.
• Be an active listener. Maintain eye contact and avoid excessive interruptions.