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

Abstract

Objective. To identify lessons learned from the experience of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety and Medical Liability (PSML) Demonstration Program. Data Sources/Study Setting. On September 9, 2009, President Obama directed the Secretary of Health and Human Services to authorize demonstration projects that put "patient safety first" with the intent of reducing preventable adverse outcomes and stemming liability costs. Seven demonstration projects received 3 years of funding from AHRQ in the summer of 2010, and the program formally came to a close in June 2015. Study Design. The seven grantees implemented complex, broad-ranging innovations addressing both patient safety and medical liability in "real-world" contexts. Some projects featured novel approaches, while others implemented adaptations of existing models. Each project was funded by AHRQ to collect data on the impact of its interventions. In addition, AHRQ funded a cross-cutting qualitative evaluation focused on lessons learned in implementing PSML interventions. Data Collection/Extraction Methods. Site visits and follow-up interviews supplemented with material abstracted from formal project reports to AHRQ. Principal Findings. The PSML demonstration projects focused on three broad approaches: (1) improving communication around adverse events through disclosure and resolution programs; (2) preventing harm through implementation of clinical "best practices"; and (3) exploring alternative methods of settling claims. Although the demonstration contributed to accumulating evidence that these kinds of interventions can positively affect outcomes, there is also evidence to suggest that these interventions can be difficult to scale. Conclusions. In addition to producing at least preliminary positive outcomes, the demonstration also lends credence to the idea that targeted interventions that improve some aspect of patient safety or malpractice performance may also contribute more broadly to institutional culture and the alignment of all parties around reducing risk

The end of the beginning: Clinical Risk and the Journal of Patient Safety and Risk Management

“…On an adjoining medico-legal front, malpractice litigation is growing. 18 The goals of malpractice law are similar to those of patient safety: to deter unsafe practices, to compensate patients injured through negligent care, and to exact corrective justice on errant practitioners.…”

Paving the Way for Progress: The Agency for Healthcare Research and Quality Patient Safety and Medical Liability Demonstration Initiative

“…After this Introduction, the Special Issue begins with a cross‐site evaluation paper authored by the initiative's evaluation team that identifies the lessons learned from this 5‐year effort for research and policy (Ridgely et al. ). The next three empirical papers in this special issue focus on improvements in obstetric and perinatal care.…”

Midwives and Liability: Results of the 2018 National Midwives and Liability Survey

“…Between 2003 and 2015, Guidera et al and McCool et al published research on midwives’ responses to adverse outcomes in practice, 1 results from 2 national surveys on the incidence and sequelae of litigation for certified nurse‐midwives (CNMs) and certified midwives (CMs), 2,3 and a closed‐claims analysis of midwifery litigation 4 . Since 2009, national attention on the intersection between adverse clinical outcomes and liability has focused on health systems culture and system responses to medical errors or adverse events, organizational communication between health care providers and patients or their family, and processes of disclosure and reconciliation 5 . In 2018, the authors, with permission of the American College of Nurse‐Midwives (ACNM), conducted the third membership survey of the litigation experience of CNMs/CMs.…”

“…4 Since 2009, national attention on the intersection between adverse clinical outcomes and liability has focused on health systems culture and system responses to medical errors or adverse events, organizational communication between health care providers and patients or their family, and processes of disclosure and reconciliation. 5 In 2018, the authors, with permission of the American College of Nurse-Midwives (ACNM), conducted the third membership survey of the litigation experience of CNMs/CMs. Questions included the frequency, cause, and outcome of lawsuits; changes in practice or professional liability insurance coverage; and emotional response to litigation.…”