The Role of Risk Management in Reducing Loss Prevention

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Definition of the Problem

Introduction

Risk management (RM) has been defined as the process of scheduling, classifying, directing, and managing organizational conduct in order to curtail the detrimental effects of fortuitous losses at reasonable costs on the organization.

Risk avoidance involves eliminating all losses associated with a particular activity, loss prevention involves reducing the chance of a mishap occurring, and loss reduction emphasize reducing the severity and impact of losses once they occur. Loss prevention techniques focus on reducing the frequency of occurrences likely to result in claims and/or lawsuits.

In health care, risk management has become an important issue during the 1980s and 1990s. The complexity of the legal environment has challenged institutions to strengthen the practice of health care to protect staff and hospitals from loss. Risk management is defined as the “science for identification, evaluation, and treatment against the risk of financial loss. Risk management also envisages the evaluation and scrutiny of medical treatment to identify and circumvent injuries to patients. It is envisaged that in most cases of medical malpractices, “In medical malpractice cases, the duty owed by the defendant physician arises from the physician-patient relationship” (Shandell & Smith, 1990, p.1-4).

What risk management is about?

RM is concerned with utilizing key functional activities of the organization to reduce the detrimental effects of accidental losses on that organization at pre-judged and predetermined costs. Further, the scope of risk management can also be extended to include aspects of recognizing, assessing, and protecting against the risks of financial losses that may arise due to risk materialization.

Further, there have been paradigm shifts in the underlying causes of fundamental issues governing risks in patient management. While at one time, the safeguards against losses or damages to the financial strengths of health care institutions and the prevalence of a reliable treatment environment were considered paramount, this has now shifted in terms of greater need for preventing harm and injury to patients by offering them a greater degree of health care protection and adequate safeguards against injuries caused by neglect by concerned health care professionals.

Thus, it can be seen that over time, the onus has shifted from the health care organization’s need to protect its health care environment from outside malpractice attacks to a more focused and perhaps narrower need to keep the best health care interests of the patient uppermost and to improve the quality of service and discharge all responsibilities vested upon the health care workers, which, it is believed would significantly reduce the occurrences of medical malpractice and issues connected therewith.

The industry’s risk manager of today faces many new and exciting challenges. By conventional practices, the job focuses on safeguarding the pecuniary trust of the organization and preserving a secure milieu. Today, the focus has broadened to include preventing patient injury and improving the quality of service. The administrator and physician must now respond and increase the emphasis on a system that can monitor, promote and guarantee the quality of service. Their objective is to alleviate malpractice judgments, cut defense expenses, and manage the insurance premium.

Background of the problem

The rising number of malpractice cases was not being reduced through prompt and speedy disposal of those cases by concerned officials. The fundamental causes for these issues to surface included issues arising out of technology advancement in medicine, which carried with it higher risks of injuries; issues arising out of worsening relationships between physicians and patients; and, problems arising out of unrealistic demands made by patients about modes of treatment and their results.

The probability of medical errors increased with the larger number of people involved in inpatient care. Risk management is used to secure the financial assets of an enterprise against the risks of calamities by assuring adequate economic protection and security against perceived and imminent occurrences of liability through appropriate risk cover strategies, including insurance of property and thus alleviating the possibility of financial losses that may accrue.

The word ‘liability ‘is used in various ways, but the general definition would be the state of being exposed to damage, danger, expenses, etc. The professional liability of the hospital is an area of great risk and all hospitals must decide on the amount of coverage they will carry. Comprehensive loss and exposure information must be collected and the data analyzed before purchasing insurance coverage. To ease the malpractice crisis, state legislators enacted a variety of laws designed to establish limits on the number of awards, set up arbitration screening panels, revised the contingency fee systems, and modified the collateral source rules.

Problem statement

Medical malpractice received a great deal of attention in the early 1970s when a crisis emerged due to the lack of availability of liability insurance. Most insurance carriers increased premiums at alarming rates, and others stopped writing malpractice coverage altogether, thereby shrinking market capacity. The increased frequency and severity of malpractice claims were the primary factors precipitating these actions. Insurers found themselves unable to adequately predict the frequency of claims or to adequately price this line of insurance. Patients will have to bear the cost and detriment caused by the lack of proper care in the health care setting due to faults caused by medical malpractice in health care.

Purpose of the study

Purpose of study

The purpose of this study is to consider the aspects of medical malpractices in a closed environment of Wayne State University Physician Group affiliated with the Detroit Medical Center Hospitals in Detroit, Michigan.

Research Questions

• Whether trusted methods are available that could identify specific medical outcomes of medical malpractices or liability incurring thereon?
• What is the extent to which a risk management program and risk managers could make difference?
• Could gaps in physician-patient relations impact medical malpractice?
• Could a collapse in communication in a physician-patient relationship result in a malpractice case?
• How could physicians avoid diagnostic errors and lawsuits?

To prevent lawsuits against hospitals and to prevent further injuries to the patient, ensure compliance with state insurance departments. Risk managers must develop a close working relationship with the persons who provide hands-on patient care. These professionals are often the first to realize that an untoward event has occurred. Risk managers must establish an open line of communication so that he or she is advised of events as soon as possible. Risk managers must develop an occurrence reporting system that these professionals understand and are willing to utilize.

Assumptions/Limitations

The study subject will be limited to Wayne State University Physician Group (WSUPG) affiliated with the Detroit Medical Center Hospitals in Detroit, Michigan.

Definitions

Summary

Risk Management has become a growing concern of all hospital administrators since the 1970s. Whether the institution is profit-motivated or not, it must be fully protected from loss to remain competitive in the health care industry. A program must be established, personnel must be educated, legal strategies must be planned, and insurance protection must be ensured. The goal is to provide quality service to the patient and to avoid negligence. The hospital should be a safe place for treatment and improving health, not a hazardous environment that creates further harm or injury to the patient.

Literature Review

The industry’s risk manager of today faces many new and exciting challenges. According to custom, the work entails maintenance of the financial stability of the institution and upholding secure surroundings. Today, the focus has broadened to include preventing patient injury and improving the quality of service. The administrator and physician must now respond and increase the emphasis on a system that can monitor, promote and guarantee the quality of service. Their goal is to reduce malpractice verdicts, cut defense costs, and control the insurance premium.

Some of the findings showed normal circumstances within the study, but not all injuries were due to negligence, and not all injuries were preventable. Due to deficiencies in prevailing systems, nearly 30% to 40% of mortality among stressed patients could be due to avoidable issues in medical attention, taking into account a wrong diagnosis and delay in providing treatment (Acute care, disability, and rehabilitation, 2006, para.1).

These findings were based on the results of studies concerning the incidence of injuries. More findings prove that the severity of the injury was more apt to be the determining factor in deciding whether a claim would arise. In conducted studies, it is seen that early research is suggestive of the fact that disabled people may not have the longevity and inferior wellbeing as they become older than people who have not been diagnosed with any kind of physical or mental inabilities (Acute care, disability, and rehabilitation, 2006, Priorities, para. 32).

The American Hospital Association (AHA) gave guidance and it helped promote the acceptance of risk management. Across the country, hospitals are quietly improving the way they provide health care services and medical attention (Umbdenstock, 2009, para.1).

Risk management entails the identification, assessment, and taking of corrective measures against threats and challenges caused by fiscal indiscipline and, inter alia, has issued directives to hospitals to enforce risk management practices as a viable solution for the impaired provision of health services.

“All medical activities that can lead to injury or death of any person, or damage to or loss of property, material, or reputation must be systematically managed regarding risk” (Grose, 2005, para.1). This could be seen as being within the scope of risk management.

Risk management also outlines the basic elements of the program and directs that the manager be someone whose training or background was in hospital administration, insurance, or safety engineering. This guideline also stipulated essential components necessary for an effective program. This description listed mandatory requirements but left space for modification that would be dependent upon the unique characteristics of the individual hospital.

“The steps of risk management are simple and straightforward:

• Identify the risk
• Analyze and evaluate the risk
• Control or eliminate the risk
• Protect the agency and the consumers of its services
• Manage any failures” (Risk management: The steps of risk management, 2002, para. 1).

In its simplest form, risk management in health care has historically focused on providing a safe environment for hospital patients. With the formation of health care systems in recent years, the scope of risk management now expands beyond the inpatient setting. Organizations have affiliated components that provide not only acute care hospitals but also the outpatient, home care, and long-term care that patients require.

The new structure of health care delivery systems brings with it the obligation to increase the scope of risk management. “Thus, establishing expectations is a first step in defining and delivering quality care and services and minimizing risk in the environment of long-term care” (Peterson, 2005, para. 1). Broadening the focus of patient care is also a risk management initiative. Research has emphasized the need for recognizing that risk management now means, the comprehension of the entire gamut of care and devising ways and means by which these could be improved. Normally, patients may receive a range of care in multiple settings from multiple providers of care.

The continuum of care needs to be the central theme of patient care, as paradigm shifts occur, new policies are enforced or the standards of care are upgraded and refurbished to meet varying needs and demands of patient care.

An effective risk management program covers all aspects of hospital operations. To achieve this goal, managers must establish early warning systems, target clinical areas or practices that present the greatest exposure to liability, and implement preventive action to minimize the risk associated with these activities. “Several professional regulatory agencies and other industry associations have worked hard to improve the quality of care provided in nursing homes (now called nursing facilities), the administration and governance of those facilities, and in turn the reputation of the overall field” (Pratt, 2009, p.73).

Risk management is primarily designed to protect the financial assets of an organization by assuring adequate financial protection against potential liability through appropriate insurance coverage, reducing liability when untoward events occur, and preventing those events that are most likely to lead to liability.

The term ‘Liability’ may be defined in various ways, but a general definition would be the state of being exposed to damage, danger, expenses, etc. The hospital’s professional liability is an area of great risk and all hospitals must decide on the amount of coverage they will carry. Comprehensive loss and exposure information must be collected and the data analyzed before purchasing insurance coverage.

First of all, it is necessary to analyze the gross patient service volume, with relation to inpatient and outpatient visits, and also determine the number of employees on staff, including full/part-time employees. It is also necessary to review any case history of previous losses and identify the number of legal expenses paid therein. Evaluating loss projections: this can be accomplished in three steps.

1. Determine the frequency and magnitude of the loss, the nature of the injury sustained is the best predictor of the value of a loss;
2. Adjust frequency averages to reflect significant future changes in hospital’s risk climate; and
3. Review the accuracy of loss payout estimates.

This is to include the settlement amount and the cost of the investigation, and defense for both paid and reversed cases. A skilled attorney should be retained for a second opinion as to the estimates of case values.

No one can estimate the amount of coverage an institution should carry, because each case differs in each area of care. Larger amounts of fund payouts are needed for meeting lawsuits awarded in court settlements. After the data has been analyzed, a risk manager would prepare for the future loss by purchasing insurance. Most hospitals “overkill” the expected loss projection and settle for the purchase of a premium that protects against catastrophic settlements and payoffs which are in the millions. Insurance coverage is paid for protection; the risk manager can further protect the institution by ensuring all health care providers work towards preventing loss within the institution.

Risk managers are responsible for developing systems to prevent injuries and other losses within the organization. Performance improvement actions are often initiated in response to suggestions offered by the risk manager. Education is also an invaluable tool in risk management and sometimes is the only activity required to prevent potential safety problems. “Patient care and accessibility to mental health services rest not only on clinical skills, but on a place to practice them and an organized system supported by staff, physical facilities and funding” (Reid, D J., & Reid, W H., 2009, Abstract, para. 1). Risk managers in many healthcare organizations are responsible for developing policies and procedures aimed at preventing accidents and injuries and reducing the organization’s risk exposure (Johns, 2002).

The specific policies and procedures that constitute a risk management program in a hospital are developed in collaboration with the hospital’s legal counsel. Judicial interpretation of statutory law in the court system is a continually evolving process and hospital leadership and governance are well-advised to seek the advice of counsel to ensure that risk management practices adequately protect the organization. Generally speaking, the infrastructure of a risk management program is designed to circumvent, or alleviate monetary setbacks, allocate funds for compensation and/or damages, and also clear the corporate image impediments caused by legal claims and lawsuits.

Prevention is a critical aspect of any effective risk-management program. Staff members need to be provided with the right kind of training and exposure to deal with emergencies, which may not be the result of their actions.

In summary, risk management has become a growing concern of all hospital administrators since the 1970s. Whether the institution is profit-motivated or not, it must be protected from loss to remain competitive in the health care industry. A program must be established, personnel must be educated, legal strategies must be planned, and insurance protection must be ensured. The goal is to provide quality service to the patient and to avoid negligent acts. The hospital should be a safe place, not a hazardous environment that creates further negligence.

Sentinel Event Statistics

This part of the study shall examine events that have a high capacity for attracting liability or cause for damages that result in lawsuits. It shall also consider ways and means by which these incidents could be prevented. According to the cases reviewed by the Joint Commission of Sentinel Event National Statistics as of June 30, 2009, there could be many kinds of surgical errors or delays that could harm, or cause death to patients, and thus give rise to criminal or civil proceedings for medical wrongdoing. High on their lists are wrong-site surgeries (13.4%), suicides (12%), operative and post-operative complications (11.1%), and delay in treatment (8%). (Appendix 1 and 2)

It would be presumptuous to blame for all kinds of errors on health care providers. However, errors caused while transfusing fluids, errors while administering injections and anesthesia, deaths caused by ventilator malfunctions, etc., do come within the purview of due services to be rendered by health care providers. Thus, they would be liable for potential legal action, at the choice of the aggrieved patient or their families.

The authors took up an empirical study on the aspects of care of patients undergoing treatment in three sections of a large urban teaching hospital. Of the total 1,047 patients being considered, 185, representing 18% had, at least one serious unfavorable consequence. The rate of such unfavorable consequences increased with the patient’s length of stay. There is a 6% probability of adverse effects increasing with every day the patients stay in the hospital. The highest incidence of mistakes (28%) occurred during the surgical intervention and daily care. During surgery, it was 10%, and intensive care patients were most likely to have critical impediments caused by medical errors (Annotated resources: Sentinel events, 2009, para. 3).

It is anticipated that there will be an increase in the findings of medical negligence against physicians as a result of the change in standards for the evaluation of medical negligence” (Medical professional liability insurance trends in Asia; Malaysia, n.d., p.3).

The increase in such cases is a cause for major concern since these incidents could trigger off suits of medical malpractices, especially if large-scale death or injury is involved.

Omissions and delays

In a typical medical malpractice case, the onus would be on whether the mistake(s) made by the nurse “amounted to deviation from standard care” and caused harm and detriment to the patient, or direct cause of death to the patient (White & Traux, 2007, p.63). In the event, the nurse was employed by doctors as an agent, or member of the group, these doctors or groups would also be legally held responsible for the injuries caused to the patient.

Utilization Management and Risk Management

Utilization Management (UM) may need to be integrated with Risk Management (RM) so that coverage of aspects such as, insurance reimbursement billing and hospital stays (typically UM functions) work in harmony with patient omissions and delays in treatment, medical malpractices, and its aftermath (typically RM functions). It is believed that in most scenarios, importance to RM may not be possible, mainly due to staff shortages, and also due to the non-critical character of its activities; thus, RM and UM must work together, to enhance the quality of treatment, eliminate or significantly reduce aspects of medical malpractice and so on.

Medical Malpractices Jury Trial Verdicts

However, it was also seen that of the medical malpractice verdicts by jury considered during the calendar year 2008, of the total of nine verdicts, eight have gone in favor of the defendants, and only one has gone in favor of the plaintiff, or the aggrieved party. This was a case involving misdiagnosis, which was settled for an amount of $2,200,000 (Medical malpractice jury trial verdicts (January 1, 2008- December 31, 2008, n.d.).

Next, it is necessary to consider the benchmarks that need to be achieved under the Operational Risk Management & Safety Assessment (ORM&SA), laid down by Wells Fargo Healthcare Group. The modus operandi for conducting such assessment would be in terms of assessing present compliances and how deficiencies in the present system to make it congruent with desired levels could be achieved. The assessment would also include compliance audits and in-depth questionnaire-aided assessments in major functional areas of health care.

Enterprise Risk Management

Again, Enterprise Risk Management (ERM) forms a major area of public and governmental accountability, including in its scope, management of emergency room, infection control, laboratory, blood bank, and transfusion controls. Again, critical areas where risks of medical malpractices could be high are obstetrics, radiology, anesthesiology, and oncology, and pain management. This is more sharply accentuated in geriatrics and post and pre-natal interventions.

According to the Wells Fargo Healthcare group, a detailed and comprehensive view of all medical and patient-related aspects of patient care must be made. According to them, “The purpose of this Operational Risk Management & Safety Assessment (ORM & SA) is to assist an organization in determining how prepared it is to retain risk as well as determine if the care that is provided to the patient meets established standards of care and other recognized benchmarks” (Wells Fargo Healthcare, n.d.).

Aspects that influence quantum of coverage

Many aspects need to be considered while taking up the question of medical malpractice in the hospital setting. For one thing, hospital administration needs to decide upon the amount of coverage that it needs to carry and this has to be laid out on a scientific and deterministic basis. For another, the coverage would depend upon several variables, which may depend upon controllable and uncontrollable factors. The major aspects that need to be covered would be gross patients and their service volume, including a breakdown of inpatient and outpatient statistics. It is also necessary to find out the number of employees, including health care professionals whose conduct could have an impact and make it subject to risks of medical malpractices.

Legal history could dictate future trends

It is evident that before a risk management program is set into place, the history of medical risks and their settlement in the context of the institution needs to be identified and assessed. It is necessary to know cases of previous litigation regarding medical malpractices that have been instituted either against the institution or against any of its constituent practitioners. If so, it is also important to know how these issues were dealt with and the extent, or amount of damages that were made by the institution, or its represented insurance agencies, or firms. This aspect is important since this would bring out the public image that is associated with this particular health care center.

Importance of public image in health care settings

It is common knowledge that, to a very large extent, the survival and growth of public health care institutions depend largely upon the public image and goodwill that it has earned over years of providing health care services to patients. However, even a few instances of medical malpractices by its constituted agents, or health care providers would be enough to earn disrepute, which could significantly impact its image and potential prospects, since few patients would be willing to visit health institutions where the medical services are compromised or neglected, inviting legal complaints and actions.

Thus, many factors impinge upon the aspect of medical malpractices, which cannot be seen in isolation but has to be seen in the context of the individual case studies. The importance of a proper methodology for seeking out how best these issues could be addressed would form the next part of this paper.

According to the practicing physicians at Wayne State University Physician Group (WSUPG), the responsibility for controlling medical malpractices vests with the profession itself (Prognosis E-New: Fieger, Howard debate merit of health courts, 2005). According to the physicians, there are reasons to believe that health courts could be the best place where medical malpractice issues could be sorted out.

The judges have well acquainted with Medical Malpractice (MM) laws and with the help of unbiased observers, the judgments for such cases would be reasonable and in the best industry practices. Besides, the fact that WSUPG sets high professional standards of medical practices could lower the rates of such malpractices and move toward a more transparent and patient-oriented system of care provision.

Data Analysis

Introduction

Since January 1989, the Joint Commission on Accreditation of Health care Organizations (JCAHO), an autonomous agency that assesses and evaluates the performance of Health Care institutions and programs in the length and breadth of the USA, has enunciated benchmarks for patient safety. Although JCAHO benchmarks are not key drivers in risk management, nevertheless, there is evidence to prove that these ethical and commercial elements are critical to any strategic planning models concerning risk management. Through this, JCAHO provides an excellent vehicle for creating a culture of patient safety and welfare.

The goal of risk management is to reduce an entity’s accidental loss of corporate assets, personnel, revenue, and reputation. Each organization’s risk management plan should include the following components: the plan’s objectives, key elements, responsibilities, methods, and areas of focus for the current year.

Risk Management Plan

• Objectives: The main aim of the internal regional medical monitoring unit is to supervise risks to reduce losses, protect resources and assets and also ensure security, safety, and stability of condition of staff members, care providers, patients, and visitors. This could be in terms of a separate unit that has been given the responsibility of taking care of the above-mentioned aspects, thus allowing other care-providing units and departments to carry out their normal routine functions.
• Key Elements: Risk management involves several key elements. The methods for implementing these elements are described later in this document. The key elements are identifications of risk issues, evaluation of areas of risk, communication of risk information, education of organizational personnel and others, and reduction of risk.
• Responsibilities: The risk manager will be responsible for managing risk management activities.

These activities include:

1. 1. Coordinating insurance coverage.
2. Managing claims against the facility.
3. Interfacing with legal counsel.
4. Identifying and analyzing areas of risk exposure.
5. Considering and proposing suitable peril management practices.
6. Mounting and upholding an information supervision scheme.
7. Executing and observing security, teaching, and quality assertion agenda.
8. Inspecting, detailing, and observing risk management data and information.

Although the risk manager has the responsibility for this plan, risk cannot be reduced without education and participation by all team members. All team members are expected to report events, follow standards of practice, identify risk events, guide the organizational mission, implement systems to reduce risks, and budget monies to solve problems. Risk managers will be available to consult with any department or manager to assist in a risk assessment of the environment or system. Risk managers will also research issues and gather additional data to assist decision-makers in the search for solutions. This research may include local, state, or national data.

Methods for Carrying Out Key Elements

Identification

The methods of identification include, and are limited to, incident reports, medical device reports, customer comment tracking forms, attorneys’ health records requests, security reports, performance improvement referrals, medical staff/peer review reports. Safety hazard reports, supervisor reports, documentation by staff and/or phone conversations with individuals who feel a need to speak about issues, and visual inspection of all areas of the organization to identify potential risk situations.

Committee membership and participation are essential for risk identification. Risk managers will assist in the credentialing process whenever there is a request or need to do so. Risk managers will research the appropriate databases and assist in obtaining profiles concerning procedures as needed or required by the medical staff bylaws. The aspect of Risk Management next needs to be seen in the context of an illustration, or example, that considers an internal structure within the health care setting called Regional Medical Center (RMC). In the case of Wayne State University Group (WSUPG), it may be the Detroit Medical Center.

There have been many issues that arise due to a lack of communication and understanding between health care providers. “Despite the complex issues we face as academic and clinical partners, WSUPG and the Detroit Medical Center share a common mission “(Wayne State University and Detroit Medical Center settle a dispute over compensation for physician services, 2009, para. 7).

Risk management will identify high-risk areas due to trends in practice, advanced changes in technology, and national data that might highlight potential areas of risk. The high-risk areas are the emergency department, obstetrics, surgery, anesthesia, critical care, and pediatrics. These areas have the potential for creating situations that can have a significant economic and emotional impact on the organization. Risk management will monitor the off-campus sites by receiving notification of any incidents that occur off-campus, as well as through periodic visits by the risk manager to each site. Maintaining information is and always will be the foundation of risk management. Most information will be maintained on the computer system for ease of data retrieval, to keep paper to a minimum, and to make record transfers easier and timely.

Regulatory agencies are constantly changing guidelines, regulations, and statutes. The risk manager will monitor changing regulations and assist team members in implementing practice changes pertinent to the regulations. Agencies that may affect the organization are JCAHO, The Centers for Medicare and Medicaid Services (CMS), state licensing boards, state and federal legislative bodies, and others.

Evaluation

A major role of the risk management department is to continuously evaluate data, systems, processes, events, documents, and departments or areas for risk. This can be done through committee participation, reporting mechanisms, such as patient satisfaction, data and incident reports, data trends such as needle sticks, and reported medication errors.

The risk management department will complete an investigation of any occurrence and rate the risk of the event. A further investigation will then occur, with priority given to all events that alter an outcome for a patient, a staff member, or a practitioner. The method of investigation will be determined by the event itself but could include data collection and review. Medical record review, committee participation, incident report investigation, making rounds in the area, consulting with specialists to assist in the investigation, including other managers, educators, insurance carriers attorneys, law enforcement and finally the process such as root- cause analysis, case study, or peer review to determine what occurred.

The leadership staff in the organization will then be responsible for changing processes or improving systems to reduce future occurrences and risk. Risk analysis will also be reported periodically to the board of directors for its overall direction. The risk management department will maintain confidential records of the analysis, including the process taken to evaluate processes that may be causing increased risks and the suggested actions for improvement. After the analysis is completed, the action steps will be implemented to solve problems or to improve the outcome for the parties involved. After changes have been made, a periodic evaluation of the success of the change will occur, and the evaluation will be reported to senior leadership.

Communication

Communication of risk management functions, information, data collection, and risk assessment is an important function within the risk management plan. The priority for communication is to inform and educate employees, physicians, customers, and others of risk issues and problem-solving processes. Confidential information will be shared only on a need-to-know basis without exception.

Risk management will determine the confidentiality of certain communication links for direct and discrete information. Communication may be directed to any or all of the following groups, as deemed appropriate: administration, medical staff, employees, patients, the board of directors, and employees. Communication to the board of directors will be done every quarter. This communication mechanism will also include performance improvement activities related to the risk management plan.

Education

Education regarding risk management activities, risk reduction, opportunities, and other ways to improve the organization is a key element of the risk management plan. The medical center will also participate in collaboration with the parent organization’s national risk management program through involvement in the Risk Management Incentive Program. Proven measures of risk reduction may result in lowered liability rates.

The measures may be in the form of general orientation, root-cause analysis sessions, special education programs, conferences, medical staff meetings, employee staff meetings, board reports, department rounds, and informal discussions. Risk management will be prepared to assist the organization in national regulatory changes that influence how the work is done. Educational opportunities will be sought out in the employee environment to reinforce the principles of risk reduction.

Reduction

The outcome of any effective risk management plan is to reduce risk. The problem-solving process of identification, evaluation, education, and communication will be the mechanism for reducing risk. The reduction of risk will provide a safer environment for patients, staff, providers, and visitors. Each of the activities will identify action steps and personnel required to resolve issues. Problem-solving activities and their outcomes will be shared through Areas of Focus in Fiscal Year 2008:

1. Timely incident reporting
2. Reduction of medication errors
3. Implementation of workplace violence program
4. Data trending of resuscitation outcomes

Attention to medical errors escalated over five years ago with the release of the study from the Institute of Medicine (IOM), To Err is Human, which found that between 44,000 and 98,000 Americans die each year in U.S. hospitals due to preventable medical errors. By far, mistakes in hospital settings list in the fifth and eighth spot as the main causes of fatality, accounting for deaths of most Americans when compared to breast cancer, road accidents, or AIDS.

Nearly five to ten percent of patients put into hospital settings are affected by major errors in treatment. These numbers may understate the problem because they do not include preventable deaths due to medical treatments outside hospitals (Kaiser, 2007). If deaths due to medical treatment outside hospitals are considered, the figures may be larger. Most often, medication errors can be attributed to one or more of the following:

• Faulty prescribing, monitoring, or refilling practices
• Inappropriate formulas
• Improper documentation
• Inadequate communication

How can physicians avoid diagnostic errors?

Expert physicians have to investigate/document all patient complaints and maintain a comprehensive record of the patient’s history by implementing a template to ensure consistency and thorough evaluation and documentation. Physicians should avoid allowing age to become a determining factor in the evaluation of a diagnosis. Review results from a previous diagnostic exam and promptly pursue further diagnostic studies. Also, ensure that a diagnostic tracking system identifies delinquent follow-up. Handwriting should be legible and easy to understand. Legibility issues are resolved through the use of electronic prescription ordering and record keeping.

The use of preprinted prescriptions for frequently prescribed compounds is another effective method of providing easily read prescriptions and avoiding illegible orders. Physicians should avoid verbal orders. If verbal orders must be given, physicians should repeat the order, spell the name of the medication, and ask for the order to be repeated to verify understanding. Alternatively, consider the use of fax transmission of prescriptions to the pharmacy to provide a written document that can be maintained in the patient’s chart (JACHO, 2005).

What are the risk exposures and hazards?

Clinical judgment is a risk exposure for physicians. Many factors underpin a general, or specific lack of data needed to reinforce a physician’s clinical diagnosis about patient care. They may include, among others, a partial or mistaken history, excess dependence on referring physician’s diagnosis without independent evaluation, inability to get a consultation, misinterpretation of diagnostic studies, insufficient office systems to monitor test results, cognitive prejudice, inadequate supervision of personnel and scarce knowledge.

How can corrective actions be implemented?

To enhance the security aspects for patients and disallow mistakes, the Government should set up a National compulsory unfavorable occasion reporting system so that health care settings disseminate information that can assist them in correcting wrong systems and procedures. Computer prescriptions could significantly reduce errors in dispensing drugs and medicines.

This would assist doctors in dealing with issues arising out of indecipherable handwriting and by routinely examining for mistakes or unsuitable drug usage.

Despite a ruling by the Institute of Medicine in 2006 that preventable medication error costs $3.58 billion annually, just 5% of hospitals have taken concrete steps to check such occurrences. Health care settings could also help by evolving systems that could control workweeks of professionals to diminish errors arising out of tiredness and a need for rest.

The Institute of Medicine (IOM) report called for a 50 percent reduction in medical errors by 2004. Unfortunately, it is not possible to quantify the number of errors today, and therefore, impossible to determine if the goal has been met. The number of errors remains high and there are many issues around substandard quality in addition to error. The 1999 IOM report focused primarily on errors in hospitals, but errors occur in other settings, such as ambulatory care and nursing homes (Bleich, 2005).

Quite often, avoidable errors may occur due to mistakes in recommending drug intakes or consumption of drugs. Eliminating medication errors need to be seen in the light of a national agenda for alleviating medication errors premised on statistical data regarding the regularity and economic costs of such errors and proof of the effectiveness of a range of preventive tools (Preventing medication errors: Quality chasm series, 2009, para.1).

Hospitals and other health care organizations decrease medical errors by using expertise, improving processes, identifying mistakes that cause damage, and building a customs of security. Empirical studies have shown that Computerized Physician Order Entry (CPOE) helps obviate medication errors. It involves entering drug orders directly into a computer system rather than on paper or orally (Vantage Professional Education, 2006). It is believed that the use of computer software for generating physicians’ orders is useful in alleviating mistakes arising out of medical errors or misrepresentations.

Various conducted studies have reinforced the need for greater use of computerized patient order entry (CPOE) which obviates ambiguity in handwriting, decimal points, or acronyms. All matters are processed digitally under this system, thereby dramatically reducing the chances for manual errors and difficulties in deciphering the handwriting of health care professionals.

Today, most Americans don’t believe the nation’s quality of care has improved. As a result, “as studies continue to point out the high rate of medical errors and their devastating effect on millions of citizens, many groups are making an effort to get patients more involved in protecting themselves” (News: New online brochure hopes to get patients more involved in protecting themselves, 2005). The probability of occurrence of various kinds of medical errors is immense. Thus, the main objective is in reducing the number of possible medical errors in various types of health care centers. Much work remains to be done and there is still much to be learned but the important issue is that systems, process improvements, and recommendations are now being set into place (Vantage Professional Education, 2006).

Doctors being human, the public needs to empathize with them for errors that could be made. But it is well within their command to reduce such errors to minimal levels. Firstly, a new technology that could significantly alleviate the probability of errors needs to be evidenced. However, till such time such errors are sought out and permanently decreased, these would continue to be the main areas of medical care.

Summary and Conclusion

Summary

The purpose of this future research is to determine ways to create a safer patient environment and awareness of safety practices among employees. Physicians play a vital role in reducing the prevalence of medical errors. Physicians should provide leadership to make patient safety a priority and to increase staff awareness of potential patient safety threats.

The problem statement dealt with the high cost of malpractice insurance premiums. Since the 90’s the nation’s health care bill has added $7 billion to the cost. The information received from the Institute of Medicine stated that by 2010 there should be a 50% reduction in medication errors. The continuation of committee reviews, implementing policy and procedures, checks and balances, education, and effective communication can avoid diagnostic errors. To achieve these goals, much work lies ahead.

For this future online survey questionnaires and interviews would be conducted with several respondents chosen specifically for this purpose. They formed an unbiased cross-section of health care professionals, members of the nursing community, physiotherapists, and other therapists who were involved in the process of health care delivery.

The underlying factor is that the best interests of the patient need to be always considered and needs to be benchmarked against the best industry practices both in terms of a measure of care and the risk management commitments and responsibilities that are taken in group and individual settings. Insurance companies and underwriters also play major roles in assessing health care insurance and its settlements due to accident or medical malpractices.

Where conflicts arise in the context of the delivery of health care, especially sharing of patient responsibility, medication, and such other issues, the underlining factor should be whether these issues are capable of causing detriment to the health and welfare of the patients and lowering the degree of care. If so, it needs to be eschewed and patient care programs need to be enforced.

There is a need for trusted methods to be developed and enforced that could consider the impact of medical malpractices in the present state, and ways and means need to be developed that could enhance patient service and care, both in qualitative and quantitative terms. There is a need for utmost trust and confidence to be exercised from both sides, to foster an environment of risk management and its smooth and effective transition into the administrative health care functioning of care centers.

In the event risk management is not given due importance, even a single incident of medical malpractice could considerably impinge upon the financial viability, goodwill, and prospects of health care institutions. The depletion of financial assets by way of damages and penalties, indulging in litigation aside, would have far-reaching implications on the authenticity and reputation of the institution.

Moreover, it could also compromise on the faith and reliance placed by patients and their careers, insurance companies, underwriters, and a host of other intermediaries and firms that do business with such institutions. Thus, it is very important and intrinsic that health care institutions, however small they may be, need to have a robust and pro-active risk management system in place, not only to safeguard the assets of the institution from being frittered away in long and expensive legal cases but more significantly, to protect the best interests of the customers, clients, and patients who are depending upon them in more ways than one.

The outcome of the deliberations with risk manager respondents may also reinforce the fact that a two-way communicating system between provider and patient is very important, and underpins the degree of trust and confidence each places on the other for the safe delivery of services and the right attitude to getting well.

Conclusions

This future research would focus on ways and means by which patient health could be made a number one priority and aspects of risk management in health care be closely monitored through the implementation of regular control mechanisms designed to keep events of risks at the barest minimum. The survey being an ongoing process that needs to consider contemporary health settings and characteristics at the time of the research program, it has been well-advised to be taken up during the time of future research for achieving the most accurate results.

The main aspects that advanced and improved health care assume in the present context is in devising ways and means and strategic decision making which envisages a heightened sense of comfort and health assurance for patients and also enhancing their standards of safety and security in terms of lesser susceptibility to injuries, greater comfort zones and ensuring the overall high standards of providing care that would not only ensure congenial patient treatment atmosphere but also afford them the desired degree of care which they are entitled to.

While individual strategies and health enforcement policies and practices vary from one health care institution to another, the fact remains that there are important broad-based guidelines that need to be adhered to, if a genuine improvement in the current health care standards is desired.

This included the clear judgment of the qualitative and quantitative aspects of medical malpractices. “If malpractice is judged inaccurately or is not clearly defined, doctors may carry out excessive tests and procedures to be able to cite as evidence that they were not negligent. Likewise, if malpractice is defined clearly but too broadly or if awards tend to be too high, doctors may engage in defensive medicine, inefficiently restrict their practices, or retire.” (Limiting tort liability for medical malpractice, 2004, para.9).

Both these situations, from the perspective of patients, are unwelcome, and thus the administration needs to take care that the patients’ rights and treatment are given the Number One priority, no matter what situational demands may be. For achieving this goal, it is also necessary that there should be a clearer and transparent communication network between patient and provider, which in effect, reduced the risks of treatment dramatically. But the communication system also needs to be suggestive of seeking the overall well-being of the patients and not only in terms of securing the provider from a risky position.

It is believed that Medication errors, arising possibly out of tort of negligence could also be a major aspect of medical malpractices. The only redeeming factor could be that the errors may have arisen advertently and not due to the gross mistake of the persons concerned. However, it is the duty of manufacturers of drugs to inform the medical fraternity/ consumers about the potential dangers of their products, etc. This could be in the form of product literature that accompanies the medication and information that is passed on to the health care practitioners during deliberations with drug product manufacturers’ representatives.

Again, it would also be incumbent on the part of physicians to explain drug reactions and contraindications to patients before administering drugs to them. Informed consent is a crucial aspect of medical practice and the consumers do have every right to know about the risks and dangers involved in using such drugs. It is also within the ambit of consumers to refuse such drugs that they feel could cause further health detriment to them, and physicians need to respect these decisions.

Another critical aspect that needs to be enlightened is that physicians need to have the complete background and medical history of patients before prescribing drugs to them. The risks of allergies could be fatal as was seen in the case of “Harris County Hospital District v. Estrada 872 S.W.2d 759 (Tex.1993).” (Learning objectives, 2000).

“Yet, in another important case with a somewhat different thrust, a patient died from an allergic reaction to a prescribed medication. Plaintiffs for the deceased alleged negligence. The court agreed, concluding that the defendants failed in their responsibility to thoroughly investigate and review potential allergic reactions for the deceased patient.” (Informed consent: What every pharmacist should know: Legislative and regulatory history, 2010, para.4).

Thus, the aspect of medical errors along with medical malpractices could be a major aspect in risk management, which could indeed be suitably guarded against, through pro-active and strategic management decision making. Increased use of technology like computer prescriptions could significantly reduce medical errors to the barest minimum and could thus reduce the liability of physicians. Besides, more efforts need to be made to “prevent medication errors by maintaining adequate stock levels of drugs on patient care units, and ensuring that health care providers order their patients’ drugs during regular pharmacy hours whenever possible.” (Granville & Rogers, 2000, p.38).

In the years to come, Medical malpractice insurance (MMI) could be a major tool that ensures the financial security of physicians during the performance of their medical functions. However prohibitive the costs of MMI may be, it is perhaps one of the options available to physicians against risks of potential financial disasters in the form of lawsuits, or medico-legal cases. It is seen that many doctors may take recourse to unethical processes to save their practice.

“In the health-care industry, many doctors report ordering unnecessary tests to avoid lawsuits” (Gryphon, 2008, para.18).

In the years to come, what is needed is to be able to strike a right balance between the need to keep patients’ needs uppermost paramount and the need for the medical profession to develop stratagems for risk management and avoidance of potential medical malpractices. “The issues of medical liability, patient safety, and just compensation for the medically injured seem to be caught in a vicious cycle.” (Bovbjerg & Raymond, 2003, p.22).

Many patients thus lose the right to their legitimate claims along with the distorted procedures and even many patients who have the rights find themselves unable to enforce them. There is a need for reform, and rightly so, in seeking and establishing norms by which the just claims of majority claimants could be expedited, normalcy and trust restored into the system that has long been vitiated by governmental interference and other bureaucratic interventions that need to do much more in terms of seeking a just and equitable settlement of patient claims and insurance settlements.

“Medical malpractice law is intended to provide physicians with an incentive to reduce errors. Regrettably, there are two good reasons to doubt that it currently does a credible job. First, researchers have been unable to detect a significant deterrent effect. Second, physicians simply do not believe that tort law rewards improved quality.” (Making hospitals accountable: Hospital-level liability could revive the dormant deterrent power of tort liability, 2009, para.16).

Under such circumstances, it is necessary that risk management in the health care arena needs to be given the due importance that is due and also undertakes ways and means by which these aspects could be enforced with a greater degree of empowerment and credibility. Besides, the aspects of patient care and comfort need to be attended to, not only as a course of professional ethics and being part of the physicians’ responsibilities but also in terms of the moral duty which physicians owe to their patients and their caregivers.

It is the attitude of the parties that need to undergo radical changes from the present bellicose and confrontationist to one of relative understanding and compatibility within the health care provider industry. This could, in effect, ensure a greater degree of harmony in patient-physician relations and could pave the way for a greater degree of efficiency and health care effectiveness within the industry.

Thus, Health care risk management is a procedure that needs to be constantly audited and monitored by the workforce regularly. The basis of this practice is through disallowing the occurrences of incidents. Pro-active dedication endeared by medical staff as well as unflinching loyalty is critical ingredients for the success of health care management programs. Every subsection is liable for disallowing dangers and controlling risks within its parameters.

Since the costs associated with occupational medical errors and malpractice is increasing dramatically in recent years, it has become imperative to effectively take care of intricate risk issues and patient safety. The sources of additional costs could be explained in terms of ineffective lawsuit expenditures, insurance costs, heightened contacts with clinical methods, differentiation in medical care, and insufficient support systems.

The challenges have never been greater, the workforce is never smaller, the technology more complicated, and patient demands never higher. Despite all these tensions, healthcare professionals and those who assist them in managing the risks associated with their responsibilities must continue to remember that, everyday patients and their families entrust their lives to them. Physicians owe it to their patients to be worthy of that trust.

Most healthcare risk managers look forward to the opportunities ahead and are dedicated to managing their organization’s risk and enhancing patient safety. The future is fraught with peril and great risk but also great reward. Those risk managers who accept change and think of new ways to embed risk management principles into their organizations to help create meaningful and sustainable change will prosper. Those who do not should get out of the field of medicine right now.

Physicians, clients, politicians, and others are very much alarmed about the rising levels of medical wrongdoings and their indemnity issues.

Medical malpractice and malpractice insurance continue to be issues of great concern to physicians, consumers, legislators, and others. Much of the deliberations about increasing malpractice insurance premiums have focused upon limiting the damage awards in malpractice cases and some thoughts have been fostered on the need for reforms in the insurance sector. Another concern that has received less public notice in malpractice discussions of recent years is patient safety.

Safety of patients refers to the gamut of rules, practices, and systems that govern the need to circumvent medical injuries, and the stratagems to obstruct medical mistakes need to be imbued in norms of patient welfare. Increasing medical malpractice insurance premiums are a growing concern in the American healthcare system. Many physicians, professional organizations, and lawmakers claim that the tort system encourages frivolous lawsuits and jackpot verdicts. To prevent a major dearth in healthcare access, strict malpractice liability restrictions, including caps on non-economic damages must be mandated.

There are doubts whether a likely and total solution for the recalcitrant malaise of malpractices could be easily found. But if true reforms are to be implemented in real terms in the health care industry, it is imperative that the reality of past failures be understood and a more rational and practical solution be worked out, that would remedy the present ills, including the prevalent tardy, costly and unjust systems now prevailing. The ability to implement health care reforms is a critical area, implementation of reform packages mustn’t be vitiated by the incompetence of administrators to address shortcomings in malpractice systems, which does act as a barrier in enforcing constructive changes in the health care industry.

Health care professionals need to find avenues for making their vision on quality assessment and physicians need to find a way to make their perspective on quality measurement and up-gradation. A change in attitudes, skills, and associates is needed. The success of doctors in taking care of these assets and avoiding conflict areas with patients would vitally affect both the future of the profession and quality dimension and progress in the U.S. health care system. An alteration in how the healthcare professional communicates with patients about harmful medical errors has begun. Within ten years, it is believed that the rapport between patient and provider would be more transparent, communicative, and robust.

Once patients are made aware of the detrimental effects of errors in medicines and their implementation by providers is effectuated, it would be a step in the right direction in renewing public confidence in the genuineness and uprightness of the health care system.

Risk Management symbolizes an ever-moving procedure in a health delivery system that can result in improved patient care and reduced accountability. An important mechanism of the process includes nurturing a good relationship with the patient, obtaining approval after appraising all facts, practicing within established guidelines, and careful documentation. A triumphant risk management program can also cause a fruitful Continuous Quality Improvement plan. An efficient risk management practice does not ignore risks. Having effectual and operational risk management shows an insurer that your business is devoted to decreasing and eliminating loss. It also builds a better risk insurance mechanism for your organization.

Risk management involves policies, processes, and procedures that identify potential operational and financial losses, prevent losses whenever possible and lessen the effects of losses that cannot be prevented. Some of the steps that are involved with risk management are identifying and analyzing potential risks, preventing and reducing the effects of accidents, medical errors, and other injuries and losses. Risk management must include a heightened sensitivity to provide a safe environment and address the emotional needs of patients. Good relationships with patients are very important in preventing malpractice suits. Public relations for health care professionals are a challenge. It is not only a good medical practice but it is at the very core of the problem of medical malpractice.

Risk management is primarily designed to protect the financial assets of an organization by assuring adequate financial protection against potential liability through appropriate insurance coverage. The main objective of risk monitoring is to reduce the chances of identified detrimental risks. This could be attained by enjoining risks management into the plans.

In real terms, implementing recommendations would envisage the injection of several new inputs required by physician groups to enforce the recommendations. These could be in terms of making provision for additional resources, assets redistribution, realigning and reallocating manpower and needed workforce towards a more well defined and charted course of action, in line with recommendations, and above all aspects of outside management intervention and control in the proceedings of health centers through outside holdings. There are sufficient advantages in pursuing this course of action for improved overall control and monitoring of activities could be gained and also raising the bar as far as improved patient management health care intervention techniques are concerned.

Recommendations

This study is future to be conducted using a closed study survey of the aspects of medical malpractices in the closed environment of Wayne State University. For this research, it would be necessary to conduct online internet interviews with members of the medical and health care providing faculty of this institution. This would be in the form of questions asked to them regarding their perceptions of medical malpractices and how to tackle such issues.

Future draft of questionnaire survey instrument

Future draft of survey instrument:

A future random sample of 50 physicians will be selected from the given sample population by lots. In this survey, 25 respondents will be physicians of multiple specialties and 25 members of the health care team consisting of physiotherapists, nurses, counselors, and other health care service providers employed by WSUPG.

It is important that in a future research survey on a sensitive topic like medical malpractices, the prior permission of the employers as well as aspects of ethical consideration like privacy and confidentiality of the information gained is also established before the survey results are released. Moreover, it is also necessary that the research team declares that the data collected would only be used for research and not commercial usage for profits, etc.

The future research methodology will involve first ascertaining the background of respondents, their age, and experience, and work duration with Wayne State University Physician Group. The main aspects that will need to be realized during this survey will be in terms of identifying specific medical outcomes or results, the role of risk management, and specifically risk managers in combating and alleviating areas of medical malpractices. Besides, the gaps in physician-patient relationships and how this could contribute to larger incidences and occurrences of medical malpractices are also major areas that need to be addressed through this survey.

Perhaps one of the major factors this survey needs to concern itself with is the quality of medical service provided could determine, to a large extent, the aspects of probable medical malpractice claims. Where there are errors, lack of care, errors on the part of the medical and nursing staff, without rejoinder of risk management, the degree of occurrences of medical malpractice cases could indeed be high when compared to safer, well detailed and planned quality and degree of care provided to patients. There are also aspects that in many cases, the injuries sustained through medical malpractice may go undocumented or unclaimed, due to a lack of knowledge and understanding among patients regarding the modus operandi of filing of claims and their eventual disposal by courts or relevant authorities.

Thus, along with the knowledge of what constitutes a case of medical malpractice and how it comes about, it is also necessary that patients are enlightened about the various technical and non-technical aspects of medical malpractice and how it impacts the acuity of care. This research methodology also needs to consider age, gender, kind of illnesses for which the aspects of medical malpractice arise, and also the steps taken by the patients to counter and be compensated for known cases of medical malpractice and its monetary value according to nature and degree of injury sustained.

The main questions that are future to be asked of the respondents will be as follows:

1. What are the major determinants for assessing the causes and impacts of medical malpractices?
2. How does the aspect of communication, or lack of it, affect the health of patients?
3. Are the risks of litigating damages in the areas of medical malpractices real?
4. What are the main purposes of Medical malpractices insurance?
5. What role does objectivity and pragmatism play in government medical malpractices?
6. How can blame be attributable and accountable in malpractice cases?
7. How the aspects of errors and mistakes could be detected and avoided?

Analysis

Further, the findings of the research proposal may prove that the majority of the issues arising are due to a lack of communication between the people involved- the patients, care providers, and the public in general. Moreover, it is seen that patients place trust and reliance on the advice and course of medication offered by professional health care specialists, and therefore, if malpractices or lack of care is established, it could well be ending in lawsuits in which the party at fault would have to pay up a large sum as compensation for damages and also other compensation as decided by the Courts. Besides, several other aspects, like the degree of care that was necessary to exercise, that which was given and the gaps in treatment are all major aspects that impact the patient’s perception and attitude towards caregivers.

The future respondents may mention that the legal protection may be sought to be made available to patients, especially those needing long-term intensive care as a major aspect. Often, health care professionals are overburdened with cases, and the lack of a suitable patient care ratio may also tend caregiving to be marginalized, specialized and individual care may, more often than not, be the privilege of the affluent class.

The results of the survey seem to indicate that more degree of care needs to be taken by providers in the health care industry to avoid patient litigation and cases of medical malpractice. “The purpose of medical malpractice insurance is twofold:

1. to protect health care practitioners from the negative economic consequences of being found negligent in their medical practices; and
2. to provide compensation for individuals who suffer harm from negligent doctors” (Medical malpractice insurance rates, 2003, Purpose of medical malpractice insurance, para.2).

Coming to the legal aspects that govern medical malpractices and their invocation, it could be said that while laws may exist, they need to be applied contextually to achieve results. It could also be seen that more emphasis needs to be placed on the objectivity part of treatment and not it’s the subjective part. Further, it is also seen that more relevance and importance needs to be given to the right modes of treatment and follow the standard and specified methods, rather than depend upon methods that are open to controversy or are not well opinionated.

The next aspect that needs to be considered in the context of medical malpractice could be in terms of how blame could be attributable and accountable and how they are presented in a court setting. It is seen that proper maintenance of official records of patients and their profiles needs to be made available on request too

risk managers and insurance companies. The records and database speak volumes about the degree of care and medication that has been followed, and through maintenance of proper records and archives, risk managers would be in a much better position to ascertain losses and pin accountability. This could also be in terms of the fact that greater impact and risk management practices need to be imbued to gain better resource allocation to patients.

Coming to the aspects of how errors and risks could be pinpointed, it could be said that the documents available to insurance companies, risk managers, and appropriate management concerns could, to a large extent, determine the amount and scope of losses and how the compensatory amounts could be gained. Further, it is also possible that a more focused and deeper insight to be established that could address the finer issues that underpin medical malpractices in the context of the health care industry.

From the future deliberations with health risk managers and their views on the aspects of risk management, it is abundantly clear that there needs to be a sound and plausible health care management system that could address all facets of patient-provider caring and also create a congenial and positive health care environment that could enhance patient treatment and early recovery.

Moreover, it is seen that in the current settings, it is important that a cohesive and well-structured risk management plan, addressing all major areas of public health accountability and patient care, irrespective of the specifics of the case and local influences, need to be formulated and executed to save future litigation and redundant health care costs. Thus, “all health care providers must focus on enhancing the effectiveness of their risk management programs” (Effective health care risk management programs, n.d., p.8). Those who are unable to do so would be marginalized for failing to provide suitable patient safety protections and would surely find insurance coverage for professional liabilities and injuries difficult to obtain and enforce.

Thus, it is not only in the best interest of the patients but also that of the provider institution to enforce a disciplined and well-rounded risk management policy that could attend to all areas of patient care and its implications on the accidental aspects of health care business. Providers who neglect or undermine such schemes may be seriously disadvantaged over time and may find themselves in a deeper quagmire than before.

For the Risk Management Program to remain successful, the researcher also recommends the enforcement of a robust action plan that envisages, among others, the setting up of a National Center for Patient Safety. This would ensure the development of an error-free reporting system that guarantees confidentiality and privacy of patients’ records. It also helps in raising the bar about performance standards and safety commitments within health care professional groups and accreditation boards.

Keeping in view the key factor of ensuring the best health and welfare interests, health care centers must implement a high degree of safety standards at the level of patient care delivery systems. There is the need for constant internal audit and monitoring to ensure that these factors are being consistently delivered and sustained through prudent and judicious planning and organizing of patient welfare programs, before, during, and after the provision of health care services in an institutionalized setting.

How do our recommendations match with things being carried out in the Wayne State University Group?

The need for a constructive and patient-centric approach has been at the heart of our recommendations, combined with a sound and plausible health care safety management system that could address all facets relating to the provision of optimum patient-provider care systems.

Hospital administration has adopted many schemes to update quality and patient security during the duration of stay in hospital settings.

This has also been the guiding principle of the Wayne State University Physician Group. Moreover, aspects like planning and organizing individualistic patient care, and safe caring which has been mentioned in this study, are regularly practiced at this health care setting at WSUG.

One of the major recommendations that could be given is that the patient’s best interests supplant other factors, especially in the case of elderly, or very young patients, who may not possess the wherewithals to take care of their health and well-being, Health is an aspect whose importance is only known after a

life-threatening crisis develops. Thus, it becomes necessary to inculcate pro-active and pre-emptive measures to circumvent, or even prevent such occurrences as humanly possible. The preventive aspect of health care is even more significant than ultimately curing diseases, especially when many kinds of ailments do not carry ID cards when it is ushered into the lives of patients and their apparent well-being. Diseases are quite capable of causing more detriment than could be visualized and given encouragement and support through medical malpractice and high uncovered risks could provide more than what patients and their care providers could have bargained for.

Instrumentation

Questionnaire Survey (considered in analysis section)

The main survey questions to be asked of the respondents will be as follows:

1. What are the major determinants for assessing the causes and impacts of medical malpractices?
2. How does the aspect of communication, or lack of it, affect the health of patients?
3. Are the risks of litigating damages in the areas of medical malpractices real?
4. What are the main purposes of Medical malpractices insurance?
5. What role does objectivity and pragmatism play in government medical malpractices?
6. How can blame be attributable and accountable in malpractice cases?
7. How the aspects of errors and mistakes could be detected and avoided?

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Appendix 1

Joint Commission National Statistics of Sentinel Events.

Appendix 2

Joint Commission National Statistics of Sentinel Events.

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