Three Steps to Meaningful Risk Management

September 9, 2016

By Dusty Otwell
Associate General Counsel
Emergency Service Partners, L.P.

Robert Otwell gave me powerful inspiration on patient quality and risk management.

If this building caught on fire, and you pulled ten people to safety, you’d make the evening news as a hero. The diligent efforts you make with patient quality and risk management regularly saves that many people, if not many more.

As EB Medicine rolls out the new ED CLEAR™ program, I reflect on my experience and the core principles that I believe lead to success in medical malpractice risk management. In the three steps to effective risk management, the first step is to truly care.

#1. Care.

In Robert Otwell’s illustration, we see the powerful impact an effective risk management initiative can have on the lives of human beings. It is easy to lose sight of this positive impact, especially for lawyers who have far more involvement in the legal defense of physicians rather than the treatment of patients. However, I believe it is essential to maintain the focus on patient outcomes and on the mission to prevent patient injuries and bad outcomes rather than on preventing lawsuits. This positive, patient-focused approach opens the mind to consider all the possible proactive measures that might improve care and prevent injuries. In contrast, focusing only on the malpractice cases, the worst-case scenarios, creates tunnel vision and usually leads only to defensive measures that have limited value in day-to-day practice.

#2. Measure.

With dedication to the patient-focused mission of preventing as many patient injuries as possible, the next step becomes clear. We must collect and analyze outcomes data.

Without a data-based approach, we fall into the traditional risk management cycle. We respond to the most recent, most terrifying case. This is a natural reaction because individual cases are gut-wrenching, even shocking, so we view them as our greatest risks. However, our feelings about these cases lead us astray. Such bad cases may result from “one in a million” risk occurrences, and focusing on them at the expense of the “one in a thousand” leaves unaddressed the vast majority of our risk profile. If we really care about the mission, we will seek out and find the risks that impact the patients and providers most frequently and most severely.

It may take some careful diplomacy to obtain the necessary data and achieve consistent reporting of outcomes. However, once we obtain the data and compare it to available national data and trends, the results that emerge will reveal the real risks we are facing. With these results, we can move to the third step.

#3. Try.

Don’t just point out the problem, try to solve it! This is another area where traditional risk management approaches fail. After identifying a risk via the presentation of a terrifying case, the program does not provide any new solutions. This inherently leaves the provider with one message. “Be afraid, and test more.” This message of fear does not ignite practice improvement or improved critical thinking. It usually just prompts defensive medicine, which does little if anything to improve care and runs counter to the growing scrutiny on costs and utilization rates.

In the very first risk management video Dr. John Bedolla and I created, we addressed spinal epidural abscesses, a terrible condition that our data analysis revealed was increasing. Our video did not leave providers with the conundrum of ordering more MRIs to guard against this condition. Rather, we offered a number of tools to better investigate a potential spinal epidural abscess presentation, including two relatively simple blood tests. Our malpractice risk for spinal epidural abscesses plummeted after publication of this video.

This simple video on spinal epidural abscesses led us to many more risks and videos, our production quality steadily improved, and our program evolved into ED CLEAR™. The principles in this article were the engines of success with our program, and these principles continue to be at the core of ED CLEAR™. We stay focused on the mission of preventing as many injuries and as much suffering as we possibly can. We diligently sift through the data to find the real risks impacting our patients, not necessarily the ones that are getting the most attention. We engage the providers with tools and strategies to improve their critical thinking related to the identified risk, rather than just scaring them. With this approach, we not only mitigate the common risks our providers face, we also help them avoid those less frequent risks, the “one in a million” risks, by virtue of the practice improvements we generate. With this approach, we have maintained exceptionally low rates of malpractice risk.

For those of you with a connection to medical malpractice risk management, I sincerely wish you success in your work to further the mission of preventing patient injuries. If your risk management efforts lead you to consider ED CLEAR™, please do not hesitate to contact me, or follow this link to the program on the EB Medicine website.

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About Emergency Service Partners, L.P.

Founded in 1988, Emergency Service Partners, L.P. is a physician practice management group specializing in hospital emergency departments (EDs). The physician-owned and physician-managed partnership serves more than 35 EDs across Texas. In addition, ESP provides pulmonary, intensive care, sleep medicine, hospitalist, and ob/gyn hospitalist services in Central Texas.