Reducing your medico-legal risk

At the very heart of reducing medico-legal risk and improving patient outcomes is the concept of risk management behaviour change.

Over the years there have been many studies into the most effective way to achieve behaviour change amongst doctors. Among them is the research conducted by patient safety expert Dr Gerald Hickson of Vanderbilt University, who examined the impact that a change in doctors’ behaviour had on patient complaints.

Based on a review of the medical literature on this subject, Dr Hickson and researchers with a similar focus (Bauchner et al , Eisenberg and Greco) identified at least 5 approaches to bringing about change:

• education
• feedback
• participation by doctors in efforts to bring about change,
• administrative rules and regulations
• financial incentives and penalties.

Specifically, they found continuing medical education with interactive interventions, educational outreach with local opinion leaders, and audit and feedback when combined with specific recommendations were particularly effective methods.

These form the foundations of Avant’s Risk IQ program, which includes our Risk Advisory Service (RAS) and Risk IQ online education program. Combining audit and feedback with continuing medical education, the RAS conducts practice visits to help members identify practice risks.

This personal approach follows that described by Ray et al (1985) ^[4], who visited doctors and shared information about their prescribing habits, made recommendations, followed up and tracked their change over time.

Dr Hickson identified that before altering their practice behaviour, doctors first must recognise the need for change.

To encourage this, he developed the Patient Advocacy System (PAS) - a peer review system that has been adopted by more than 100 US healthcare sites. Similarly, Avant has created a risk-management benchmarking survey tool to help doctors understand their risk and identify if behavioural change is required.

Available to all our members, the Avant Risk IQ Benchmark Survey enables doctors to self-rate their own behaviours across 11 dimensions of risk management for non-proceduralists and 14 for proceduralists.

The dimensions were developed through a review of established domains of risk management used in Australia and internationally, as well as a review of literature on claims analysis and risk management strategies.

After completing the survey – which takes around 15 to 20 minutes - members receive a report outlining their self-assessed scores against other members who completed the assessment, including by location and specialty. It’s important to note that the survey is not linked to Avant member records and is not used in connection with policies.

In addition to the report, Avant members are given links to Risk IQ online content that is relevant to their situation and risk profile. Based on the benchmarking survey results, these resources are sorted by risk dimension and help improve the likelihood of behavioural change.

Our Avant Risk IQ Benchmark Survey responses so far have revealed that the more claims a respondent has had in the five years prior to completing the survey, the higher the self-rated responses, which indicated a greater awareness of risk.

A greater awareness of risk is the first step towards preventing claims and improving patient outcomes.

References:

1 Figley et al First do no Self-harm: Understanding and promoting Physician Stress Resilience (2013, OUP)