Not “Just” an Employee How medical office s taff c an h elp p revent m alpractice l awsuits

1. Not “Just” an EmployeeHow medical office staff can help prevent malpractice lawsuits MGMA Annual Conference October 2013 Pamela Willis, BSN, JD, RN Patient Safety/Risk Management Account Executive

2. Presentation Goals • Understand liability exposure in the medical office • Recognize the role of office staff in helping preventmalpractice 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 Not Just an Employee / 2

3. I’m Just an Employee… Isn’t malpractice all about the doctor? Not Just an Employee / 3

4. Understand Your Role... You make a difference... The physician’s office staff is the first line of defense against a medical malpractice lawsuit. Not Just an Employee / 4

5. 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? Not Just an Employee / 5

6. 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! Not Just an Employee / 6

7. Closed Claim Data 2007-2012 * Communication is rarely the only issue; cases are influenced by other factors including severity of injury. Not Just an Employee / 7

8. 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. Not Just an Employee / 8

9. Communication Statistics Miscommunication can lead to poor patient outcomes, misunderstandings, and lawsuits. Not Just an Employee / 9

10. 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 Not Just an Employee / 10

11. 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 Not Just an Employee / 11

12. 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 Not Just an Employee / 12

13. 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 Not Just an Employee / 13

14. 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. Not Just an Employee / 14

15. 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 Not Just an Employee / 15

16. 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 Not Just an Employee / 16

17. 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 Not Just an Employee / 17

18. Apologize for the Situation “I’m sorry you are going through this…it must be very frustrating for you.” Not Just an Employee / 18

19. 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 Not Just an Employee / 19

20. 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 Not Just an Employee / 20

21. “Your most unhappy customers are your greatest source of learning” Bill Gates Business @ The Speed of Thought Not Just an Employee / 21

22. 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 resultseven normal • Document that notification has occurred • Assure that recommended follow-up occurs Not Just an Employee / 22

23. 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: • The test is ordered • The result is received • The provider signs off on the result • Follow-up instructions are received from provider • The result is reported to the patient • Follow-up is facilitated and carried out • Any breakdown in the chain is documented! Not Just an Employee / 23

24. 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 Not Just an Employee / 24

25. 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 Not Just an Employee / 25

26. Remember… • 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! Not Just an Employee / 26

27. Complimentary Resources… For additional Patient Safety information, please visit www.thedoctors.com • pwillis@thedoctors.com • (800) 421-2368, ext. 1716 Our mission is to advance, protect, and reward the practice of good medicine. Not Just an Employee / 27