Vital Insights from 10 Years of Malpractice Claims

November 16, 2020 - Two decades ago, the Institute of Medicine published To Err Is Human, a landmark report that brought attention to medical error and became a catalyst for the patient safety movement. Around the 10-year anniversary of the report, a number of articles and studies were published that examined the impact of this movement. Nearly all concluded that it was too early to assess whether significant change had taken place.

Now, new data indicates efforts after the 20-year anniversary mark have not progressed as expected. It raises vital questions and renewed areas of focus for the healthcare industry.

Data reveals drivers of risk to inform future change

Malpractice data derived from 11,907 events pertaining to 20,211 closed claims across a 10-year period (2010 to 2019) received an in-depth analysis.

Robert Hanscom, Vice President of Risk Management and Analytics at Coverys explains, "Over the years, we've created a rich comparative benchmarking database that captures the key drivers of risk. Our data can best be described as 'signal data'--signals from the past that can inform the future and help identify if vulnerabilities that were at the root of these events are still in play."

By examining claims data at an event level, risk managers, clinicians, and healthcare executives can get a unique view into factors that lead to claims and how to proactively reduce conditions that result in patient harm and financial risk. It provides a foundation for a national-level examination into risk management issues and causation factors.

The data shows improvement in select areas such as increased patient engagement, flattened hierarchies and the ability for staff at all levels to raise concerns, increased teamwork, and better sharing of information. However, many areas remain largely unchanged. Improvement has not happened quickly and collectively as it needs to.

Key claims trends

Following are a few of the key trends uncovered in this malpractice data:

• Physician Claims Trends: Change has been fairly stagnant over the past decade. Patients continue to experience high-severity injury outcomes, and clinicians and organizations are seeing increasingly high financial payouts. Despite lower claim rates, average indemnity and expenses are trending upward. The overall closed with indemnity paid rate is essentially flat, averaging slightly over 23 percent.

• Top Claims Trends: Surgery/procedure-related allegations are the most frequent, followed closely by diagnosis-related allegations--combined they account for 57 percent of allegations and 59 percent of indemnity paid. Allegations related to medical treatment (12.5 percent), medication (8.8 percent), and obstetrics (4.4 percent) round out the top five allegation types. The specialties most likely to have two or more claims filed against them are surgery and obstetrics. On a positive note, the overall claims rate for anesthesiology decreased significantly over the 10-year period. A focus on simulation training, human factors engineering, and evidence-based decision-making is credited for this improvement.

• Persistent Existing Risks: Allegations related to communication breakdowns, retained foreign bodies, and hospital-acquired infections were identified as persistent risks that exhibit flat or increasing trends. The top allegation categories involving communication risks are diagnosis-related, surgery/procedure-related, and medication-related. The overall volume of retained foreign bodies is low, but average indemnity paid is rising. The number of hospital-acquired infection events is low, but rising slowly.

• Emerging Risks: Urgent care settings, electronic health records (EHRs), telehealth, robotics, and the increase in advanced practice providers (APPs) are identified as areas of emerging risk. The most frequent and costly allegations for both urgent care settings and EHRs are diagnosis-related. The growth in telehealth is expected to bring many risk issues to the surface, including overreliance on technology, failure to appropriately document care, and diagnosing conditions without a traditional clinical evaluation. The majority of robotic allegations are surgery/procedure-related with urological surgery cited as the most common area of surgery followed by gastrointestinal. There are relatively few events involving APPs, but the count is rising, and this trend is expected to continue as the population of APPs grows.

Implementing Action Toward Improvement

The past 10 years have been challenging for an already overextended healthcare workforce. Rising litigation costs, higher severity claims, and more stringent reimbursement mandates put pressure on the bottom line. Continued challenges and crises (e.g., the COVID-19 pandemic, opioid epidemic, and natural disasters) in combination with less-than-optimal interoperability and design of health information systems, physician burnout, and loss of patient trust, have put front-line clinicians and staff under tremendous pressure. A focus on the signals that actionable data provides can help develop and maintain initiatives and implement them in a way that can yield sustained results.

Following are questions healthcare leaders should consider as they work to innovate, design, and implement action toward improvement:

• How are you resourcing your organization to learn from failure?
• How do you ensure learning happens and is applied widely from the board room to the frontline?
• How are you partnering within your organization and the broader healthcare community to empower in-house leaders to achieve improvements?
• How are you engaging decision-makers to commit to sustained improvement?
• How do you demonstrate your responsibility and accountability to engage with front-line staff and patients if the momentum for improvement initiatives is lagging?
• How are you tracking constant, emerging, and future operational, cultural, and clinical risks to prepare for them?
• How are you ensuring the transparency needed to drive learning and improvement?

Utilizing data insights can give us unique perspectives into where vulnerabilities exist and provides sharp focus on where proactive steps can be taken to prevent adverse outcomes.

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Coverys is a leading provider of medical professional liability insurance. We are committed to providing data-driven insights and proactive risk management and education to improve patient safety and quality outcomes. Our services are designed to help reduce distractions and improve clinical, operational, and financial outcomes.