THE ROLE OF THE STATE :

1. THE ROLE OF THE STATE: • CAN GOVERNMENT HELP HOSPITALS TO EMBRACE PATIENT SAFETY MEASURES AND REDUCE MEDICAL LIABILITY COSTS? October 5, 2011 1

2. THE NEW YORK SITUATION • 2007: Medical Malpractice Crisis? • Task Force on Medical Liability Reform convened: • trial lawyers, bar association, legislators, insurers, patient advocates, hospitals, ACOG, midwives, hospital associations, provider groups, etc. HHC Program mentioned (Health and Hospitals Corporation of NYC). But no one invited the judiciary…. 2

3. AGENCY FOR HEALTHCARE RESEARCH & QUALITY (AHRQ) SOLICITED PROPOSALS THAT: • put patient safety first and work to reduce preventable injuries; • - and – • foster better communication between doctors and their patients; • - and - • ensure that patients are fairly and quickly compensated for legitimate medical injuries, while also reducing the incidence of frivolous lawsuits; • - and - • reduce escalating liability premiums.

4. PROJECT TEAM New York State Unified Court System New York State Department of Health 5 Academic Medical Centers in New York City _____________ Judge Douglas E. McKeon, NYS Supreme Court Richard C. Boothman, UMHC Michelle Mello, HSPH

5. The NY Model: 3 Project Components • Develop & Enhance A Culture Of Patient Safety • Create And Implement A Communication & Resolution Program (CRP) • Expand and Enhance Judge-directed Negotiation Program

7. Assumption The Culture of Safety can be Improved by: • Developing an action plan based on the results of culture of safety survey • Just Culture • TeamSTEPPS • Creating patient safety initiatives identified through adverse events • Sign outs and handoffs • WHO Surgical Checklist • and Creating a Communication and Resolution Program. 7

8. a communication and resolution program will promote fairer, quicker compensation for medical injuries, improve provider-patient communication, and reduce litigation costs, frivolous claims and malpractice premiums Assumption • Develop policies and procedures for adverse event response and settlement • Provide training for disclosure and communication • Implement the program and gather and analyze data

9. Expanding and Enhancing a Judge-Directed Negotiation Program will save money and time Assumption • Identify judges to participate in judge-directed negotiations • Train judges in targeted medical knowledge • Train judges in enhanced negotiation and mediation techniques • Provide neutral RN/JD for medical expertise 9

10. In the Hospitals • Patient Safety Teams • Administer Survey of Safety Culture, analyze results, develop an action plan. • Establish a system to increase adverse event reporting. • Look in the mirror. Identify weaknesses. • Identify and shepherd interventions. • Communication and Resolution Teams • Develop a comprehensive policy and process for disclosure, discussion and where appropriate, compensation. • Obtain staff buy-in and provide training. 10

11. BARRIERS AND FEARS • This will make costs go up, not down • We already do this • Systems and checklists stifle excellence • [New York] is different • It’s just a few bad apples • Mandatory reporting (NPDB, etc.) • What we need is tort reform 11

12. The State: Can it get the horse to drink? • HOSPITALS DO NOT TRUST THE DEPARTMENT OF HEALTH • And why should they? • THEY DON’T LIKE TO BE TOLD THEY SHOULD CHANGE. • Who does? • THEY WANT TO DO THE RIGHT THING. BUT THEY’RE SCARED OF THE BOTTOM LINE. • You’ve got to make the financial case. • Use a carrot, not a stick. You can be the pilot light. 12