Force won’t work: the best leaders never bully, but lead by example. Forecasting medicolegal risk would allow medicolegal institutions (eg, liability insurers, medical boards, hospital risk management departments) to become more proactive in quality and safety improvement efforts, argued Professor David Studdert, Professor and ARC Laureate Fellow at the University of Melbourne. His study is using a unique national dataset on patient complaints against Australian doctors to develop new methods and tools for predicting a clinician’s risk of a further complaint. Over a ten-year period, 18,900 complaints were received about 11,000 doctors in Australia.
The research looked at practitioners’ sex, age, practice location and specialty. For all practitioners, standards of clinical care and communication were the main issues. The more complaints a doctor received, the more they were at risk of further complaints. Prof Studdert explained how the PRONE score (PRobability Of New Events) predicts doctors’ medicolegal risk, which could be used as a simple prediction tool for targeting interventions and reducing clinical negligence costs.
Tony Mason, former Chief Executive of MPS, explored the rise in negligence costs in a global context. For some doctors and hospitals, they have already proved to be unsustainable; in the UK, clinical negligence costs are the highest anywhere in the world, except the United States. The Panel Discussion provoked a lively debate about potential ways forward to address this unsustainable rise.
But the fallout from an adverse event is often not about the money... It is about communicating effectively when things go wrong
But the fallout from an adverse event is often not about the money, argued Dr Lucian Leape, Adjunct Professor of Health Policy at Harvard School of Public Health, in his keynote address on disclosure and apology. It is about communicating effectively when things go wrong. A serious preventable injury is devastating for the patient – they are doubly wounded. Not only do they suffer a physical wound (the adverse event), they also suffer an emotional wound, the betrayal and loss of trust in the healthcare professional. A serious preventable injury is a medical emergency. If a doctor does not act quickly, things become much worse. The necessary treatment is open, honest and full communication.
In this medical emergency, there is a second victim, the caregiver. Shame, guilt and fear can take over if the situation is ignored. Apologising or admitting something has gone wrong can be difficult, yet Dr Leape suggests it is essential for the caregiver to heal. Dr Stephanie Bown agreed, outlining MPS’s belief in the necessity of a culture of openness. Legislation cannot work: it only serves to encourage fearful behaviour. Mistakes do occur. Quality, however, is never an accident: it is always the result of high intentions, said Dr Jason Leitch, Clinical Director at The Quality Unit, Scottish Government, in his keynote address on safety and outcomes.
Safer care can only be delivered by frontline professionals doing common things uncommonly well. To achieve a culture of safety, we need a culture of improvement. John Tiernan, Director of MPS Educational Services, closed the two-day conference with a question: “Delegates from around the world have come to the conference and will leave with great ideas. What will you do with the information you have learnt?”