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Patient Safety Programs and The Decline in Claims Frequency: Can Statistical Analysis Provide Insight on Correlation vs. Cause?
By Terrance J. Sheehan, MD
President & CEO
The Institute of Medicine released a controversial
report in the year 1999 titled To Err Is
Human. The report stated that thousands of
deaths each year are due to medical error. And
while most in the medical community believe
that faulty methodology in the study misstated
the error-related mortality statistics, it nevertheless
served as a wake-up call that shook the industry. One of
the key recommendations of the report called for healthcare
organizations to implement meaningful patient safety programs.
When I first became President of Medical Mutual, I wrote in
my first annual report message in the spring of 2006 that, "I
firmly believe one of our most valuable resources to improving
the care environment lies in the experience that comes from evaluating
and handling claims for the past 28 years. By analyzing
that experience and leveraging the insights gained from it, our
Risk Management and Claims Department professionals have
implemented changes to improve care… Our whole focus has
always been on system analysis and improvement, using evidencebased
quality improvement and patient safety concepts."
Since then, the Company has used such concepts to enhance
its already industry-leading risk management services through
case-based seminars, practice manager workshops, office practice
surveys and hospital education programs. Coincidentally — or
not — both the healthcare industry at large and Medical Mutual
have experienced a sustained reduction in claims frequency.
There certainly appears to be a correlation between the drop in
claims frequency and implementation of concerted patient safety
initiatives. But while the correlation is interesting and encouraging,
no one could argue convincingly at this moment in time that the
collective patient safety initiatives implemented since the Institute's
1999 report have actually caused the reduction in claims frequency.
Wouldn't it be great, though, if we had statistically-analyzed data
to make that argument in a more convincing fashion? That would
mean that, as I have hypothesized previously, we have indeed
reached a new, lower set point for claims frequency. It would prove
the value of quality improvement efforts in patient care and encourage
additional efforts, not to mention the positive effects it would
have on medical professional liability rates going forward.
All of which is why I have asked our chief actuary, Kevin
Atinsky, FCAS, MAAA, to embark on the tall task of conducting
a statistical analysis that begins testing the hypothesis. I say tall
task because any such analysis, at least at this point, is subject to
caveats. (See the reprint of Kevin's article on the subject on page
four of this publication, which recently appeared in the Second
Quarter 2009 issue of Physician Insurer.) Nevertheless, any new
insight into the question will be valuable insight.
In the meantime, let us all continue our vigilant focus on
patient safety and quality improvement in the everyday practice
of our profession.