Insights From a Decade of Malpractice Claims

Twenty years after To Err Is Human, the 1999 report by the Institute of Medicine that served as a major catalyst for healthcare transformation, we examine how things are progressing today.

In our new report, A Call for Action: Insights From a Decade of Malpractice Claims, we explore how efforts in the decade following the 10-year anniversary of To Err Is Human have not delivered optimal results. It raises vital questions and renewed areas of focus, not just for Coverys but for the healthcare industry at large.

Data informs change

Data provides a glimpse into our past to inform the future. The data in our report is derived from 11,907 events pertaining to 20,211 closed claims at Coverys across a 10-year period from 2010 to 2019. The ability to parse and examine claims and event data from many angles enables us to understand trends, reveal fresh insights, and make recommendations to help improve patient safety.

A closer look at some of the trends and risks we examine in our new report:

• Physician Claims Trends: Change in this area has been fairly stagnant over the past decade. Patients continue to experience high-severity injury outcomes, and clinicians and organizations are seeing increasingly high financial payouts. Demands on physicians are burdensome, with burnout widespread and rising. Factors include the influence of health information technology, production pressures, and overall reduction in workplace satisfaction. Our data shows these efforts are not necessarily having the desired impact.
• Top Claims Trends: Slight modifications in the claims data and improvements in diagnosis are promising. However, given the outcomes stemming from missed and delayed diagnosis scenarios—and the resultant higher-than-average payouts, there is more to be done. We focus on what can be learned from events in our key data-driven target areas: surgery, diagnosis, medical treatment, medication, and obstetrics.
• Persistent Existing Risks: There is wide awareness of tenacious threats to healthcare and the tools and tactics in place to prevent them. Awareness, however, has not always translated into action. Fortunately, there is growing openness toward sharing stories, collecting data, and distributing knowledge to help address these threats. There is also continued interest from organizations and clinicians to examine their own claims data and adverse events to help reduce risk and improve patient care.
• Emerging Risks: Malpractice data looks to the past and provides us with rich signals as to where patient care and provider exposure to claims remain vulnerable in today’s healthcare settings. Areas of concern can be quickly prioritized if data shows issues that led to preventable adverse outcomes still exist. But concurrently, we must always keep our eye on emerging risks. Problem areas we see surfacing are related to new technology, novel procedures, and current events that are developing at a rapid pace.

Not time to relax

There has been palpable effort and consensus on the need to reduce risk and improve patient care over the past two decades; yet our malpractice data does not reveal collective success. Pressure is mounting to achieve improvement: financial, relational, and reputational. Expectations for change are high. In the midst of significant and complex issues that compete for your attention, it is vitally important not to relax your efforts to provide safe, high-quality care.

The past 10 years have been challenging for an already overextended healthcare workforce. Rising litigation costs, higher severity claims, and more stringent reimbursement mandates put pressure on the bottom line. Continued challenges and crises (such as the COVID-19 pandemic, opioid epidemic, and natural disasters) in combination with less-than-optimal interoperability and design of health information systems, physician burnout, and loss of patient trust, have put front-line clinicians and staff under tremendous pressure. It is critical to engage beyond the day to day. A focus on the signals that actionable data provides can help develop and maintain initiatives and implement them in a way that can yield sustained results.

While our data suggest there are not significant overarching wins over the past 10 years, we do see that influences in the broad expanse of healthcare are driving improvement. A Call for Action: Insights From a Decade of Malpractice Claims can give you a unique perspective into where vulnerabilities exist and provides sharp focus on where proactive, preventive steps can be taken to prevent adverse outcomes. For more, download our full report now