Transcript Ambulatory Care: Digital Documentation Risks and Benefits

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
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
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I’m Just an Employee…
Isn’t malpractice all about
the doctor?
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Understand Your Role...
You make a difference...
The physician’s office staff is
the first line of defense against
a medical malpractice lawsuit.
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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
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Did I get what I expected?
Did I get better?
Did they care about me?
Did the physician and staff
project confidence?
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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!
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Closed Claim Data 2007-2012
* Communication is rarely the only issue; cases are influenced
by other factors including severity of injury.
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Where Communication Breaks Down
Key information is unknown or not passed along
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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.
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Communication Statistics
Miscommunication can lead to poor patient outcomes,
misunderstandings, and lawsuits.
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How Can Staff Help?
• Avoid yes/no questions
 Do you understand?
 Do you have any questions?
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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
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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
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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
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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.
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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
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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.
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Staff Telephone Communication Tips
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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
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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
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The Challenging Patient
The complaining, demanding patient wants to:
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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
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Apologize for the Situation
“I’m sorry you are going
through this…it must be
very frustrating for you.”
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Handling Challenging Patients
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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
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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
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“Your most unhappy customers
are your greatest
source of learning”
Bill Gates
Business @ The Speed of Thought
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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!
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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
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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:
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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!
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Documentation
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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
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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
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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
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Remember…
• 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!
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Complimentary Resources…
For additional Patient Safety
information, please visit
www.thedoctors.com
[email protected]
(800) 421-2368, ext. 1716
Our mission is to advance,
protect, and reward the
practice of good medicine.
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