Top Drivers of Risk and Malpractice Claims

In this blog series, Lori Atkinson discusses the top drivers of risk and malpractice claims and explores strategies to mitigate risk and enhance patient safety.

In my risk and patient safety work with physicians and healthcare organizations, I am frequently asked, "What are my top malpractice risks, and how do I prioritize risk management initiatives to address them?"

I look at the claims data to answer these questions. Understanding the top risk drivers in a specific healthcare setting or specialty provides data-driven insights into what initiatives to prioritize and how to engage team members in the "why" of those process improvement initiatives.

At Curi, I'm part of a team that analyzes malpractice claims to identify and examine the top malpractice allegations, the top clinicians and care teams responsible for adverse events, and the top factors contributing to events and claims. We then provide clients with Risk Reports that outline the top risks and include risk mitigation strategies and related resources to improve team performance and reduce risk.

1. Surgical
2. Medical
3. Diagnostic
4. Obstetrical
5. Falls

Surgical allegations
In our analysis of a subset of Curi malpractice claims, surgical allegations are number one in occurrence and cost. Surgical allegations are split between technical performance issues and improper patient management issues.

The top risk factors identified as contributing to surgical adverse events and claims include:

• Technical skill issues, including known complications of a procedure
• Clinical judgment issues, including patient assessment and selection of the procedure
• Communication breakdowns among the care team and with patients/families
• Patient noncompliance and seeking other care because of dissatisfaction with outcomes
• Documentation issues

Onboarding new surgeons to reduce risk
Last year, one of the best risk conferences I attended was our virtual event, Working Together to Improve Patient Outcomes. Curi board member Dr. Kourtney Kemp gave a presentation about onboarding new-to-practice surgeons to reduce surgical errors and claims.

Dr. Kemp shared that the first few years of a surgeon's career are critical, and early challenges can plague them for the remainder of their careers. She noted that these challenges can be debilitating, personally isolating, and can lead to adverse events.

In her presentation, she discussed creating a cohesive surgical team by building trust through challenging times, mastering healthy conflict, ensuring all voices on the team are heard, and implementing a comprehensive new surgeon onboarding program.

Mastering healthy conflict
Dr. Kemp emphasized that whether there is a conflict with family, friends, or colleagues, a continuation of that conflict can feel like a dark cloud. However, working through conflict can lead to resolution and have a long-lasting positive impact on team dynamics.

She noted that mastering conflict in healthcare extends to the patient and family members. Dr. Kemp recommends asking questions if you, as the surgeon, sense undertones of conflict. 

• Don't avoid it. Dive into it.
• Ask questions with positive intent and avoid unhealthy behaviors such as a negative tone, defensiveness, overbearing with logic in an overly critical way, pointing to issues elsewhere, and appearing impatient or rushed.
• Take your time with conflict and use it as a valuable opportunity and tool to strengthen your relationships and team.

New surgeon onboarding recommendations
Dr. Kemp's new surgeon onboarding recommendations include "copiloting" new surgeons and enhancing team culture by:

• Pairing an experienced surgeon to assist the new surgeon in the operating room (OR)
• Pairing the new surgeon as a first assistant with an experienced surgeon in the OR
• Building trust inside the OR by familiarizing the surgeons and the OR team
• Building trust outside the OR by providing the new surgeon with frequent feedback on surgical performance, including mastering healthy conflict
• Providing frequent check-ins between the new surgeon and their mentor for 6-12 months

Other recommendations for leaders and administrators
Ensure a new surgeon receives orientation to a hospital's policies, procedures, and equipment

• Arrange "warm" introductions to other team members, such as anesthesiology and OR nursing teams.
• Provide opportunities to run emergency drills for managing critical complications.

Curi clients, sign in to our Risk Solutions Resource Catalog to take our Surgical Risk Assessment, view data-informed Risk Reports, and watch the CME accredited video, Claims Insights: Mitigating Surgical Adverse Events.

If you have questions about this topic, please call 800-328-5532 to speak with one of Curi Advisory's Risk Solutions Consultants.

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