Becker's Clinical Quality & Infection Control

Sign up for the Free Becker's Clinical Quality & Infection Control E-Weekly at www.beckersasc.com/clinicalquality. tom line is that evidence-based guidelines eliminate variations in care and give patients the best results scientific evidence can provide. The process is an incredibly collaborative one, and as such it requires robust support from administrators so it can take root, grow and flourish. Among other things, it requires effective administrative mediators and explicit support for clinicians and staff in quality-improvement endeavors. It's no secret, Dr. Marroquin of UPMC says, that getting consensus from groups of different physicians can sometimes be astonishingly difficult. The administrator's role is to embrace the opportunity to sit in the middle and facilitate the process of reaching an agreement. "Leadership at highest level must say 'this is important, we are going to do this, and we are going to transform ourselves,'" he says. Institutional support goes beyond mediation, however. Hospitals and hospital systems should strive to establish long-term goals guiding quality improve- 4 Tips to Implement a Transparent Medical Error Disclosure Policy (continued from page 1) What disclosure is really about: Safe patient care While these results are impressive, the true value of the program is in higher quality and safer care, according to Rick Boothman, JD, chief risk officer of UMHS. "It is important to understand that our approach is not just about achieving savings in claims; at the heart of our approach is a deep commitment to learning from our mistakes and improving the quality of our care," he says. "Transparency is not just a strategy for handling claims. The core value of transparency is that it is absolutely necessary if we're going to improve the quality of medical care." Replicating the Michigan Model Here are some tips to implement a transparent medical error disclosure policy in a hospital or health system. 1. Communicate the benefit to providers. Being honest with patients about medical complications, whether due to a provider error or not, benefits both patients and providers. When a mistake is made, being honest with a patient enables providers to learn from their error. When providers did not make a mistake, acknowledging this fact instills confidence in them. Being honest with patients can also save providers from needless litigation — an outcome opposite of many people's expectations, according to Mr. Boothman. "We didn't open a floodgate of claims by admitting we've had our own share of problems," he says. 2. Designate a physician advocate. Hospitals should designate a leader in the risk management department to be a physician advocate to encourage openness. "I have never advertised myself as a patient's advocate," Mr. Boothman 11 ments. Among hospitals represented here, MemorialCare Health System has instituted safety goals informing the system's patient-centered philosophy on treating conditions with high rates of mortality, frequency or complication. St. Luke's has made a quality-minded triple commitment to be physicianled, have an infrastructure of physician leaders and practice evidence-based medicine where it exists. Carroll Hospital Center not only supports quality improvement within its own institution, but also makes an effort to participate in every Maryland statewide collaborative contributing to research supporting guidelines and best practices in guideline implementation. Hospital leadership can make permanent quality gains from evidence-based guidelines a reality when it supports its clinicians in improving quality, facilitates discussions among interested parties makes a commitment to try, reform and maintain guidelines and institutes norms of evidence-based practice. n says. "I know what I'm doing directly benefits patient care and patients, but it's important for me to say to staff, 'I'm here for you.'" Having someone to support providers through the disclosure process is critical for building trust with providers and encouraging openness. 3. Ease others' fears. One of the biggest challenges to implementing a transparent disclosure policy is resistance from people who feel their job is threatened by a new approach to medical errors and malpractice, according to Mr. Boothman. Hospitals' defense lawyers are typically the most resistant to this change, possibly because they believe their job may not fit in the new model, he says. "The industry, which has been built around a deny-and-defend mentality, is very threatened by this. But if our heart is in the right place and we want to do the right thing by our clients — doctors and hospitals — [the transparent approach] makes too much sense," he says. 4. Consider the role of insurance. UMHS is self-insured for malpractice insurance, which, while not a requirement for its disclosure model, does make the policy easier to implement, according to Mr. Boothman. First, being selfinsured guarantees that the malpractice claims policy aligns with a goal of quality care. "An independent insurance company does not have the same interest that a self-insured institution like ours would have in terms of an abiding interest in quality of care," Mr. Boothman says. In addition, being self-insured eliminates the challenges associated with working with an outside company. "We don't have another corporate voice to deal with," he says. Committing to medical error transparency Ultimately, committing to transparency with medical complications and errors is critical to improving quality and patient safety, and has the added benefit of potential savings in reduced malpractice claims. Being honest with patients builds trust and strengthens the relationship between patients and providers. "[Malpractice challenges] are never going to get better until we embrace the notion that all parties — patients, families and caregivers — are in this together," Mr. Boothman says. n MORE ONLINE: Want more information on healthcare transparency and quality? See the following articles available at www.BeckersHospitalReview.com: n 5 Must-Haves for a Hospital Pa" tient Safety Program" (May, 2013) n Dr. Toby Cosgrove: Transpar" ency in Healthcare is 'The Right Thing to Do'" (May, 2013) n Responding to Physician Rating " Sites With Transparent Patient Satisfaction Data" (April, 2013)

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