Deal with Difficult Doctors…
Reduce Claims Payments
with Associate Dean for Clinical Affairs Gerald B. Hickson, MD, Vanderbilt University Medical Center, Nashville, TN
Dr. Gerald Hickson, director of the Center for Patient and Professional Advocacy (CPPA) at Vanderbilt University Medical Center, likes to hear patients and healthcare professionals complain. Hickson knows it’s not a perfect world, and he wants patients to share their comments, suggestions, and complaints about how to improve Vanderbilt’s quality of care. In addition, he wants professionals to identify and address any unprofessional behaviors exhibited by their colleagues.
“Finding dissatisfied patients is like mining for gold nuggets,” he says, “and addressing disruptive behaviors observed by staff that pose threats to patient safety is exactly the same. We want to know what both have to say and how we can make things better.”
Hickson’s quest to make medicine kinder and safer, which has become part of business-asusual at the hospital where he has spent his entire 30-year career, has helped make Vanderbilt one of the nation’s most respected medical care facilities. Vanderbilt University and the medical center (650 bed hospital and 250 bed children’s hospital) were recently named one of Fortune magazine’s “100 Best Companies to Work For,” the first such institution to appear on that list. In addition, Vanderbilt currently ranks 15th out of 5,453 medical centers on the U.S. News and World Report “honor roll.”
Joint Commission Issues Sentinel Alert
Hickson says he is gratified that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), on July 9, 2008, issued Sentinel Alert #40 “Behaviors that Undermine a Culture of Safety.” The new standard requires hospitals to have codes of conduct and policies to manage unprofessional behavior.
“I am glad the Joint Commission’s alert challenges us to create environments that will not tolerate unprofessional behavior, because we’ve seen far too many examples where such behavior affects the care patients receive,” Hickson says.
“The Joint Commission and Vanderbilt both recognize that sometimes we get used to a culture and certain behaviors that we shouldn’t,” he continues. “And in any effort to change a culture, you begin by making people aware if their behavior is not consistent with an institution’s credo or values. Healthcare professionals need to be part of a process that provides behavior-related information, provides them chances to reflect and develop insight, and holds them accountable.”
Hickson and CPPA faculty offer workshops and programs designed to help others become more conscious of the impact of unprofessional behavior in the operating rooms and clinics that may harm patients and lead to unnecessary visits to the courtroom. CPPA regularly conducts these courses not only for Vanderbilt’s medical and nursing students, but also for healthcare professionals worldwide.
Hickson says that, while exact numbers are hard to quantify, he believes that the CPPA’s work at Vanderbilt has not only helped promote good medical practices, but has provided a substantial financial return on Vanderbilt’s investment in the program.
Claims Rate Falls by Over 80%
“Specifically, since beginning our work 10 years ago,” Hickson says, “our claims rate has fallen by over 80%, and we conservatively estimate a return on investment of at least 5 to 1 in terms of the cost of operating the CPPA intervention process versus reduced claims expense.” Hickson is quick to add, however, “It’s almost impossible to fully understand the specific actions that produced these excellent risk management outcomes, because we’ve taken many steps at Vanderbilt to improve quality and to make medicine kinder and safer.
“First and foremost, our goal is to reduce unnecessary conflict in medicine and promote good outcomes,” Hickson says. “If reduced malpractice claims result, that’s even better.”
Guiding Principles Offer Opportunity
Hickson says that some “guiding principles” can help ensure that disruptive health professionals are given opportunities to improve. “If I were behaving in unprofessional ways, I would want to know, and I would want an opportunity to respond,” Hickson says. So to that end, we follow the four guiding principles.”
Hickson says that, by following these practices and others, healthcare can become kinder and safer everywhere. “We need to do everything we can to make fewer and fewer patients unhappy,” he says. “I firmly believe it can be done through education, increased awareness, great leadership, and a commitment to mutual accountability.”
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