Honesty In The Best Policy: UM Approach To Medical Error Spreads
ANN ARBOR — For just over a decade, the University of Michigan Health System has been a leader in demonstrating a new way to handle patient safety and malpractice concerns.
The approach has simultaneously promoted safer care; helped patients, their families and clinical staff deal with unanticipated outcomes in a non-adversarial way; and saved UMHS money at the same time.
Now, just as seven major Massachusetts hospitals and their state medical society have announced they will emulate this approach, UMHS leaders are offering a manual for other hospitals to do the same.
In a new paper in Frontiers of Health Services Management , published by the American College of Healthcare Executives, the team lays out the basic principles of the Michigan Claims Management Model — and tips for implementing it.
The paper reviews the path that UMHS took in creating the honesty-based, patient safety-focused approach, identifies the essential practical components of the Michigan Model, offers suggestions for tailoring the approach to other settings, and presents some thoughts on the future of this approach.
The paper is co-authored by UMHS chief risk officer Rick Boothman, chief medical officer Darrell “Skip” Campbell, Jr., and Sarah Imhoff, MHSA, a UMHS administrative intern and Georgetown University law student.
The key principles, write the authors, are to compensate patients quickly and fairly when unreasonable medical care caused injury, to support caregivers and the organization vigorously if the care was reasonable or did not adversely affect the clinical outcome, and reduce patient injuries (and therefore claims) by learning through patients’ experiences.
The authors warn that the UMHS approach goes far beyond “apology” policies that have been advocated elsewhere, and replace the “deny and defend” approach still in place at most hospitals.
“To understand the Michigan Model, it is critical to understand that the claims management process is only the public face of an organic culture shift that seeks to elevate patient safety to the foreground and relegate claims considerations to the background,” they write.
But the impact on malpractice claims is undeniable. By using and refining the Michigan Model, UMHS has lowered its average monthly cost rates for total liability, patient compensation and non-compensation legal costs.
The average monthly rate of new claims has dropped from 7.03 to 4.52 claims per 100,000 patient encounters, the average monthly rate of lawsuits has dropped from 2.13 to 0.75 per 100,000 patient encounters, and the time between claim reporting and resolution has dropped dramatically.
The new paper lays out critical components of the model that other hospitals should implement in order to have the best outcome:
* Capturing Clinical Issues, because problems cannot be fixed if problems are not known * Identification of Medical Errors, to distinguish unfortunate clinical outcomes that warrant compensation from adverse outcomes that occurred despite reasonable care. * Communication among patients, families, and caregivers * Compensation for injuries made by medical error * Learning from mistakes to ensure that future patients are not harmed * Measurement to provide evidence of change and facilitate return-on-investment analyses * Resources, including ensuring that the right people are in the right roles
These principles are now being implemented in Massachusetts by seven hospitals that, together with the Massachusetts Medical Society, announced last week they will pilot an approach patterned on the Michigan model.
The new paper, and other documentation of the UMHS success including an independent 2010 analysis published as a paper in the Annals of Internal Medicine, can help other hospitals do what the Massachusetts hospitals are doing.
In the end, the authors write, the honesty-based model represents a sustainable path forward for American hospitals.
“The collateral damage from deny and defend has been underappreciated. Its impact has long obscured the direct connection between lapses in patient safety and medical malpractice litigation,” they say. “Its direct, albeit unintended, consequences include a fundamental failure to accept responsibility for patient injuries caused by true medical error, and that failure in turn accounts for decades of needless litigation and all of its attendant personal, financial, and ethical costs. Abandoning deny and defend can be a critical first step to recovery.”
For more about the Michigan Claims Management Model, visit www.med.umich.edu/news/newsroom/mm.htm