The threat of a potential malpractice suit is never far away. Start with the patients—they are less loyal, less trustful, and more demanding than they were in days gone by. These attitudes can quickly turn to anger, frustration, and pointing fingers when their expectations aren’t meant. Take heed, good doctors, having the best training and clinical skills is not enough! Protecting yourself from risk involves the actions and non-actions of everyone in the practice.
Approaching risk management at your practice
A common-sense approach to risk management deals with many aspects surrounding patient care—the way you operate your practice. If you give these matters the attention they deserve, it will go a long way in keeping you out of court. Let’s look at what you can do to reduce the potential risk.
Building patient relationships
It’s not your job to be friends with the patients, but it is your responsibility to be friendly. Take it seriously. People are not likely to sue the people they really like, so make sure your patients like you and see you as an ally.
If you think most patients select their physicians based on clinical skills you may be misled. Most patients pick their doctors and recommend them to their friends based on how much they like the doctor and how good she makes them “feel.” Their confidence in your skills and judgment is subjective. They assume you are clinically competent.
Beyond the clinical mission of diagnosing and treating a problem, medical practice leaders would be wise to dedicate more time to being personable with patients and set an example that inspires staff to do the same. Strive to meet both the wants and needs of the patients. If most patient satisfaction is based on how you make the patient feel, it makes sense to treat the person, not just the condition. Following are a few things you can do that make a difference.
I have conducted mystery patient visits for doctors across the country and been amazed at the lack of attention to patients. Many practices have sign-in sheets, an excuse not to greet patients. Seldom does a staff member introduce herself or properly greet me, including the nurse who escorts me to the room. And no one welcomes me to the practice. Generally, only the physician introduces himself. I wonder, why haven’t they trained staff to do the same?
These visits inspired me to develop rules that I’d like to see adapted in every medical office. It’s bound to result in a more cooperative, compliant, and satisfied patient.
The golden rules for managing risk:
1. Everyone in the office (not just the physicians) should greet new patients by introducing themselves. This is an important first step that is often overlooked by staff. It goes a long way in making patients feel welcome and important.
2. Call patients by name repeatedly during the encounter. It makes them feel connected and cared about.
3. Read the chart notes before you go in the exam room so you are familiar with the patient’s history and why he is there. If your nurse has taken the history and recorded the symptoms this should not be difficult. Patients don’t like it when you ask them why they are there when they just told your nurse.
4. Once the exam is completed, sit in a chair to talk with the patient. Looking down on patients makes them feel inferior. You want patients to know and “feel” that you are connected and care about more than their condition.
5. Get personal. It only takes a few minutes to ask a patient about his hobbies, job, or family and it leaves a powerful impression.
6. Apologize if you’re late and, for heaven’s sake, don’t act rushed. Your patients deserve your time. If you are relaxed and calm, they feel they have both your attention and your time.
7. Never ask a patient a question unless you are willing to listen to his response with your full attention. Look at the patient when either of you is speaking. Avoid looking at his chart or electronic medical record while conversing, and don’t interrupt the patient.
8. Avoid medical jargon that the patient is unlikely to understand.
9. Ask for affirmation once you’ve provided the diagnosis and treatment plan and willingly repeat instructions if necessary.
10. At the end of each encounter, verify that the patient understands his condition and treatment, and ask if he has any other questions. It will make him feel important and is likely to reduce phone calls that disrupt workflow later on.
Do and give more to nurture the relationship. For example, when a patient has an office-based operative procedure or has been in the hospital, why not have the nurse call the patient the following day to see how she is doing? When the doctor is delayed and the patient is waiting in an exam room, the nurse should tell her there has been a delay and ask if there is anything she can do for the patient during the wait.
Staff can play an integral role in getting patients connected to other services such as “Meals on Wheels” or “Dial a Ride.” Finally, train your staff to always ask the patient, “Is there anything else I can do for you?” before the patient leaves the office or at the end of a phone call.
The purpose of facility audits
Part of making the patient feel valued is making certain your office is inviting and aesthetically pleasing. The reception room should feel like a comfortable living room. After all, the patients are your guests. It’s also important to update the furnishings every five to seven years. Inspect the facility several times each year and make sure it passes muster.
* Furniture and flooring clean and without obvious wear
* Comfortable seating, some with arms to aid frail people to maneuver in and out
* Room temperature in the mid to high seventies with good ventilation
* Sufficient lighting throughout for reading
* Variety of reading materials
* A coat rack
* Sound barrier so staff conversations cannot be overheard
* No sliding window
* No sign-in sheet
The importance of documentation and tracking
If it isn’t written it didn’t happen—or so the story goes. Physicians are faced with this reality when it comes time to defend their records in court. It’s not just a matter of getting things documented—it’s a matter of legibility, timeliness, and identifying who wrote what and when. Document as you go—in real time—for both accuracy and promptness. Also, require anyone who writes in the chart to initial and date the entry. More than likely, you can obtain documentation guidelines from your malpractice carrier. I suggest using these guidelines to conduct a training session with your staff.
Implement effective tracking systems for following up on diagnostic studies and post-visit care for patients. Most computer systems provide tracking tools for patient recalls and with the advent of the electronic medical record, more sophisticated tracking applications are available.
If your computer does not provide the tools you need, implement a dependable manual system. A master log can be created to document all studies ordered, received, and reported to the patient. When it comes to follow-up appointments or repeat tests, it’s best to get them on the books. If the patient chooses not to schedule the activity, a reminder will be required. If the computer system cannot accommodate this, tickler files can be created by documenting the patient’s name and follow-up needs on a 3×5 card to be placed in the file by the month action is required. Of course, systems are only as good as the people using them. Consistency and accountability are critical to the credibility of any system.
Risk management accountability is best achieved by establishing standards, consistently applying them, and monitoring performance. Begin with the basics and develop standard protocols regarding patient care essentials.
* Rooming a patient: Preparation and documentation requirements
* Clinical telephone calls: How they are recorded and response time requirements
* Actions and documentation related to missed appointments
* Documentation requirements for patient encounters
* Documentation and communication requirements for diagnostic studies
* Chart maintenance
* Release of medical information
* Informed consent
* Follow-up studies and recall appointments
Standards and procedures for each of these should be written into a risk management plan for the practice. This then becomes a tool for training new physicians and staff, and holding everyone accountable.
Risk management is a silent duty. Sometimes the silence doesn’t get attention until a problem emerges. Don’t put your practice in this position. Develop a patient-friendly culture. Train staff to be advocates for the patients; focusing on their comfort and their needs. Common-sense risk management plays an important role in reducing risk exposure, so make it a priority in your office.
Judy Capko is a health-care consultant with more than 20 years experience. She is a national lecturer and author of Secrets of the Best-Run Practices. Her focus is practice operations, staffing, finance, and strategic planning. Judy can be reached through the website by email: email@example.com.