1. Not “Just” an Employee How 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 prevent malpractice 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 breakdown that 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 quality of 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: 1)The test is ordered 2)The result is received 3)The provider signs off on the result 4)Follow-up instructions are received from provider 5)The result is reported to the patient 6)Follow-up is facilitated and carried out 7)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. Recognize that as office staff you are the first line of defense against malpractice liability Understand your role in enhancing the patient experience and building rapport Be the office that truly cares about its patients You can make a difference every day! Remember… 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 Not Just an Employee / 27 Our mission is to advance, protect, and reward the practice of good medicine.