Over the last few weeks, I’ve been writing about healthcare professional liability, medical malpractice liability coverage, at least once a week. My previous posts have included an overview of this coverage, how social inflation is impacting claims and the options available to healthcare providers looking for coverage.
Communication: A Critical Factor
This week I would like to focus on how claims related to communication can be prevented. In 2020 a study, see highlights here and here, was conducted by Constellation Insurance, now known as Curi, to analyze the claims their insureds experienced. That study found that communication was a contributing factor in 35% of claims resulting in harm and accounted for $223,000,000 in claim payouts over a 7-year span.
What I found interesting about this study was that 67% of those claims stemmed from communication among the provider team, with another 41% stemming from communication with the patient or their family. Prior to reading the study I would have guessed the opposite.
Challenges in Provider Communication
Communication between providers is essential to managing and streamlining the patient experience. Incomplete patient information transfer, inconsistent medical records, a lack of coordination and the failure to follow up can all contribute to miscommunication between providers. There are several challenges healthcare providers face when it comes to communication.
Tech for healthcare providers is a nearly $150 billion dollar industry in America alone and that number is predicted to climb to over $700 billion by 2032. With so many options hitting the market annually, especially in the EMR (electronic medical record) sector, it can be tremendously challenging for providers to keep up with changes in these technologies.
More and more health systems, and at times even mid-sized medical groups, are turning to locum tenens, temporary or traveling, providers to help fill gaps as the staffing struggles brought on by the recent pandemic have continued. With key elements of provider staff continually changing it can be extremely difficult to establish streamlined and consistent policies and procedures.
Without consistent policies and procedures, or when the time required to continually train non-permanent members of staff in these policies and procedures is unsustainable, it becomes more difficult to establish standardized handover protocols. These protocols are designed to help maintain continuity in patient care and without them providers are forced to do their best at filling in any gaps in information that should not exist in the first place.
There’s also an established hierarchy that exists within healthcare, whether or not the organization wants to admit it. These hierarchies work very well when communication is efficient but when communication breaks down, these hierarchies can be detrimental. Pride, egos and professionalism can all outweigh the real priority, the patient, when the environment is dysfunctional.
A lack of coordination, unfamiliarity with existing technology, inconsistency in policies and procedures and poor communication fueled by dysfunction can all prevent the necessary follow-ups from occurring that are often required to ensure proper diagnoses and treatment. Without these follow-ups the chances of malpractice claims are increased exponentially.
Challenges in Patient Communication
Communication, or a lack of it, with patients and their family may not have contributed to as many claims as communication among providers but that doesn’t mean it isn’t equally important. Patients rightfully expect to understand their condition(s), be heard, understood, and respected, receive explicit treatment plans as well as fully understand the risks associated with those treatments.
Healthcare providers have years of schooling, training and in most cases experience with the extremely broad variety of conditions they are treating on a daily basis. It can be very easy to either assume that patients understand these conditions or be on autopilot when working with patients. Most patients only experience and understanding of medical conditions is limited solely to their own ailments.
Many providers work long shifts, have any number of responsibilities and are treating patients who, in some cases, are not easy to work with. As such, the incentive to end the interaction as quickly as possible has never been higher. This can create an environment where assumptions are made, among other issues, that can leave patients feeling like they’re not being heard or understood.
Informed consent is a critical element of providing healthcare but when there are communication issues between providers and patients it can easily lead to those patients not understanding the implications of the discussions they’ve had with their providers. This can create disastrous outcomes that may have been avoided if the patient fully comprehended the risks.
Strategies for Improvement
Whether you’re working to address communication between providers or between providers and their patients, unfortunately there is no quick and easy solution to address these challenges. That being said, the change must start from the top down. Organizational change is never an easy thing to accomplish but with the right strategic leadership that change stands a fighting chance.
Some of the issues I’ve mentioned thus far can be improved by procedures as simple as checklists, written and visual aids and automated reminders to providers and administration staff. Having a checklist that addresses standardized handover protocols as well as complete and accurate entries into EMRs will not fix every problem related to these challenges but are a step in the right direction.
Written and visual aids can not only help patients better understand diagnoses, treatment plans and their options but again, they are a step in the right direction. It may seem like something as simple as an infographic won’t make a difference but in many cases people learn better visually. A clearly and concisely written description of conditions, in laymen’s terms, could be the difference between that patient grasping their condition and feeling confused.
With so much advancement in healthcare tech there are a wide variety of options for EMRs and other programs that can provide automated reminders not only to patients but also to their providers, practice administrators and even referral providers when a practice isn’t fully equipped to meet their patient’s needs.
Efficient and consistent training is not an easy task for any organization, especially those that rely heavily on professional contract labor, but just because it’s not easy doesn’t mean it’s not worth evaluating. There is no solution that will be correct for every organization but there’s no shortage of help, LMS (learning management systems), third party training and comprehensive training programs have all improved significantly in recent years. As with anything, it’s essential to do a comprehensive evaluation of all the options available to your organization.
Cultivating Effective Communication
Active and empathetic listening can largely depend on the multitude of different personality types that make up your staff but there are ways to help providers, and administrative staff, improve. There’s no shortage of educational resources, books, professionals, workshops, seminars or apps that can help your staff improve their listening. As uncomfortable as it may be, role playing can help people understand what it’s like to be in their patients shoes and gain a perspective they may have forgotten they had from their lives before healthcare.
Impact on Liability and Patient Experience
Not only can improved communication impact your claims experience but it will also undoubtedly impact your patients’ experience as well. This will not only help control costs related to future malpractice liability premiums but also reduce the costs associated with claims that may not be covered, prevent reputational harm, lead to a better image within the communities your organization serves and could even help you attract top talent.
Conclusion
Part of the Hippocratic Oath states: “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability.” We are all human beings, we all have hard days, won’t get along with everyone, have issues outside of our careers that can impact every aspect of our lives and challenges to overcome. However, healthcare providers made the decision to treat patients, plane and simple. Communication will not always be easy but it is absolutely essential that we do everything we can to get it right.
About the author
Drew Colwell is a commercial insurance agent and risk manager who specializes in working with nonprofit organizations, healthcare providers and other human service related businesses all over the US. His contact information is below.
Phone: 406-204-3666
Email: andrewc@wafdinsurance.com
LinkedIn: https://www.linkedin.com/in/drewcolwell/