What Is the Relationship Between Patient Safety Outcomes and Malpractice Claiming?
The conventional logic behind malpractice liability in tort is based on deterring provider negligence. But in recent years, policymakers and health care providers have become increasingly interested in the relationships between patient safety, preventable medical injuries, and medical malpractice claiming. Specifically, they argue that many preventable medical injuries result from complex system failures, that most medical providers genuinely want to keep their patients safe, and that the combination of quality-improvement activities and root-cause analysis can be an effective tool for reducing the occurrence of injuries. By extension, they argue that improving safety performance could improve the medical liability climate and reduce the volume of malpractice litigation across the United States. But this outcome has not yet been systematically demonstrated.
A recent RAND Corporation study set out to do just that. The study focused on California—a large, diverse state that adopted statutory reforms 35 years ago to discourage malpractice lawsuits and, consequently, a state in which recently observed changes in the volume of malpractice litigation are unlikely to be attributable to the impact of tort reform. The study examined state administrative safety data for hospitals from 2001 through 2005 and related those data to the volume of malpractice claiming, by county and by year, over the same period. Specifically, it applied Patient Safety Indicators developed by the Agency for Healthcare Research and Quality—indicators that capture 20 distinct classes of in-hospital events and complications with the potential to harm patients—to statewide hospital encounter data for California. The researchers also constructed a database of malpractice claims from four of the largest physician medical liability carriers in California, covering the same five-year period.
In terms of broad California trends in adverse safety outcomes and malpractice claiming, the study found that both declined slightly statewide over the five-year period, but there was considerable variation across California's counties and from year to year. As for the relationship between safety outcomes and malpractice claims, the study found a highly significant correlation between the frequency of adverse events and malpractice claims: A county with a decrease of 10 adverse events in a given year would also see a decrease of 3.7 malpractice claims; and conversely, a county with an increase of 10 adverse events in a given year would also see an increase of 3.7 malpractice claims.
According to the research, nearly three-fourths of the variation in within-county annual malpractice claiming can be accounted for by the changes in patient safety outcomes. The study also showed that similar correlations hold true when the results are broken out for surgeons, nonsurgical physicians, and obstetrician/gynecologists.
The key policy implication of this work is that improving patient safety has the potential to benefit both patients and providers. Ultimately, research may be able to link specific safety practices to improved health outcomes and reduced malpractice claiming—a major objective of new large-scale demonstration projects called for by President Barack Obama in the fall of 2009. In the meantime, the focus on patient safety could garner support from both sides of the highly politicized debate over medical malpractice policy and health care reform more generally.
A History of Medical Malpractice Research
The research showing that better patient safety is linked to fewer medical malpractice claims in California adds to a body of groundbreaking RAND medical malpractice research. In 2007, RAND produced a study that examined whether policies that target physicians who make medical malpractice payments—specifically, using payment histories to decide which physicians will be investigated, and possibly sanctioned, by the state medical board, and making information about individual physicians and their payment histories available to the public—would reduce negligent injuries. The researchers found that neither of these policies would substantially reduce the incidence of malpractice because the medical malpractice system does not accurately identify and extract compensation from physicians who injure their patients through negligence.
In 2004, RAND researchers analyzed the effects of California's Medical Injury Compensation Reform Act (MICRA), which limited non-economic damages to $250,000 and has served as a model to policymakers across the country for reforming medical malpractice laws. They found that MICRA led to a sizable drop in aggregate and average final judgments; however, with a sharp drop in plaintiff attorney fees and large economic awards, net recoveries are nearly the same with MICRA.
RAND Institute for Civil Justice provides objective research on civil justice issues. ICJ studies can be found at www.rand.org/icj.
Michael Greenberg is a lawyer and a clinical psychologist by training. Greenberg's work at RAND has included empirical research on topics spanning civil justice, healthcare, and national security. He has recently led or co-led several research projects at RAND, including a study examining the relationship between safety outcomes in hospitals and malpractice claiming against providers and a survey of medical malpractice plaintiffs' attorneys. Greenberg is also the director of the RAND Center for Corporate Ethics and Governance, where he coordinates RAND Corporation research pertaining to related issues. In the latter role, Greenberg will be leading an invitation-only conference event on May 12 in Washington D.C., entitled "Directors as Guardians of Ethics and Compliance within the Corporate Citadel: What the Policy Community Should Know."
Read more about Michael Greenberg »
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