LAWYERS - THE FIRST CLINICAL RISK MANAGERS?
Stats:-
National Audit Office - MN Claims up from 78m in 1996/97 to 145m in 1997/98.
MDU - damages of 67m including 5.5m paid for surgical errors, were paid to patients in 1998 for doctor's mistakes or negligence according to the annual review of the MDU. Which represents about 65000 registered practitioners. Claims have increased at 15% annually
Medical Protection Society - GPs are 13 times more likely to be successfully sued by patients than they were 10 years ago.
In 1981 Alexander Harris, a niche health litigation practice, wre approached by a victim of a medical accident. Due to inadequate anaesthesia she had been awake and conscious of pain during a caesarean section but was paralysed and unable to communicate her distress to those around her. Four years later the woman received £14,000 compensation in a landmark legal victory against the hospital authorities. The shortcomings highlighted following the legal procedure, enabled hospitals to analyse anaesthesia procedures for mothers in need of Caesarean sections ensuring that they could be revised and improved.
Over the past ten years lawyers at Alexander Harris have recovered damages in excess of 30million for clients who have been injured as a result of negligent healthcare treatment. The cost of negligence claims to the NHS is reported to be in excess of 100million per year, which not only includes claims for clinical negligence but also employer and public liability claims. The recognition of risk management in addressing complaints has never been more important in improving the future care of patients and reducing litigation. By employing a risk management process throughout the organisation, Trusts now find themselves in a stronger position in being able to proactively prevent or reduce the occurrence of claims. The work at Alexander Harris has highlighted clinical problem areas and through this identification has enabled hospitals to analyse areas of concern and improve procedures.
In the past identifying problems through the use of the legal system was the most effective way that hospitals were able to locate areas of risk. In fact it could be said that claimants lawyers, in highlighting cases where healthcare treatment was substandard and resulted in injury to the patient, were the first risk managers. In the last five years the NHS has moved on, with many hospitals employing risk managers and having risk management groups. Their function is to be as proactive as possible for both patients and employees. If they are not able to be proactive then they need to be retroactive - dissecting why injury or deficiency occurred in a certain case and determining how to deal with a complaint so that it doesn't happen in the future.
Lawyers and Hospitals are all striving for the same outcome - by identifying areas of care which have been poor, seeking justice for the patient can help in the hospital identifying problems and taking steps to improve to minimise the risk of such cases occurring again.
An important element in reducing claims is the ability to identify problem areas in advance and deal with managing the possibility of risk as proactively as possible - as soon as possible. The ultimate goal is to manage clinical risk reducing the incidences of events and thus be in a position to treat the cause rather than the effect. Opportunities lie not only in assessing formally reported events where the chances for litigation are high, but in those events which constitute 'near misses' where lessons can be learnt at no cost to the patient or the hospital and actions taken to ensure that potential problems are addressed before they occur.
To enable these processes to take place, good communication systems which enable the sharing of knowledge and information are key. Forums where doctors can discuss mistakes and analyse problems enable them to learn lessons so that they can plan for the future. Complaints from staff and patients should be discussed openly and honestly and with necessary speed. If hospitals are slow to recognise areas of risk then as patients get injured lawyers will be there to deal with the problems.
It is very easy to blame others for shortfalls in service provision - lawyers for the increase in medico-legal litigation, the emerging public culture of 'sue, sue, sue,' the government for not giving enough money, and so on. Healthcare providers need to also look at themselves and ask of themselves 'could we have and should we have' identified a certain problem in advance. For risk management to be effective a culture change is required where healthcare providers recognise that they are also part of the problem and that risk managers need to be preventative treating the cause rather than reactive in dealing with the effect. Until this occurs risk management is pointless. The message is clear, all parties can work together in developing both the safety of care for patients and a better healthcare system which proactively plans to reduce risks for patients and staff alike.
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