The “Seven Pillars” Response to Patient Safety Incidents: Effects on Medical Liability Processes and Outcomes

Abstract

Objective. To determine whether a communication and resolution approach to patient harm is associated with changes in medical liability processes and outcomes. Data Sources/Study Setting. Administrative, safety, and risk management data from the University of Illinois Hospital and Health Sciences System, from 2002 to 2014. Study Design. Single health system, interrupted time series design. Using MannWhitney U tests and segmented regression models, we compared means and trends in incident reports, claims, event analyses, patient communication consults, legal fees, costs per claim, settlements, and self-insurance expenses before and after the implementation of the "Seven Pillars" communication and resolution intervention. Data Collection Methods. Queried databases maintained by Department of Safety and Risk Management and the Department of Administrative Services at UIH. Extracted data from risk module of the Midas incident reporting system. Principal Findings. The intervention nearly doubled the number of incident reports, halved the number of claims, and reduced legal fees and costs as well as total costs per claim, settlement amounts, and self-insurance costs. Conclusions. A communication and optimal resolution (CANDOR) approach to adverse events was associated with long-lasting, clinically and financially significant changes in a large set of core medical liability process and outcome measures.

Lessons Learned from a Systems Approach to Engaging Patients and Families in Patient Safety Transformation

“…Yet they can be ineffective in the absence of strong institutional partnership. 15 , 22 , 36-38 System PFACQS members were engaged as codesigners of several systemwide safety programs, including HRO, 39 CANDOR 36 ,[40][41][42][43] program implementation, our We Want to Know program for patient safety event reporting, [44][45][46][47][48] and most recently, advancing awareness and detection of sepsis. 49 These efforts engaged not only the system PFACQS but also local members to drive systemwide improvements in quality and safety.…”

Changes in Physician Practice Patterns after Implementation of a Communication‐and‐Resolution Program

“…In April 2006, the UIH adopted a novel strategy for managing its professional liability risk by instituting a CRP (Lambert et al. ). This program marked a complete reversal of the medical center's earlier risk management strategy of categorically denying negligence and refusing payment after an adverse event, which in the eyes of many had triggered a number of avoidable lawsuits.…”

Progress at the Intersection of Patient Safety and Medical Liability: Insights from the AHRQ Patient Safety and Medical Liability Demonstration Program

“…; Helmchen, Lambert, and McDonald ; Lambert et al. ; Mello et al. ), there is also ample evidence from the PSML portfolio to suggest that DRPs are difficult to scale, to disseminate, and to implement across multiple institutions and in nonacademic settings (Mello et al.…”

“…The Illinois project demonstrated the impact of “Seven Pillars” in its academic medical setting (Lambert et al. ) but failed to produce impact data for the replication of the model across the 10 participating community hospitals. In the Washington project, very few claims were referred to the nascent DRPs—starving the project of any demonstrable quantitative impact (Mello et al.…”

“…The projects showed that under optimal conditions, DRPs can produce measurable, positive impacts on a series of patient safety and medical liability outcome measures (Lambert et al. ). The projects also showed that under suboptimal conditions, DRPs can be quite difficult to implement; different stakeholder groups may have understandably different perspectives regarding the attractiveness and risk implications of DRP (Mello et al.…”