RISK MANAGEMENT

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RISK MANAGEMENT In Medical Practice
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• Dr Jonathan Burdon, FRACP
• President,
• The Medical Defence Association of Victoria

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What is Risk?
The chance of something happening that will have
an impact upon objectives. It is measured in
terms of consequence and likelihood and implies
the potential for unexpected or unwanted
outcomes
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The chance of a claim being made against a GP in
any one year

• General Practitioner Non Procedural 23 yrs
• General Practitioner Procedural 13 yrs
• General Practitioner Procedural
• including Obstetrics 14 yrs

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of All Claims and Costs against GPs
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What is Risk Management?
Risk Management is doing it wrong less often
Quality assurance is getting it right more often.
It is a process, not a person, not a
framework. It should be core to what we do in
healthcare, not an extra, not an add-on. you
cannot change the human condition, but you can
change the condition under which humans
work. (J. Reason)
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Benefits of good risk management for the Medical
Practice

• Improved patient care
• Reduced likelihood of adverse outcomes
• Reduced stress from being sued or disciplined
• Slowing growth in indemnity costs
• Professional and business satisfaction

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Risk exists in healthcare. The challenge is how
best to manage it.
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Influences on patient outcome
Proper skill and care Patient selection
Competency and experience
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Influences on patient experience

• Time assessing patient
• Answering patients questions
• Staff presentation and manner
• Competency and experience
• Supporting equipment
• Body language/interest/eye contact
• Communication with patient and relatives
• Managing patient expectations

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Influences on claim severity

• Quality of record keeping
• Disclosures and comments to patients
• Co-operation with legal and mediation process
• Record storage

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Practitioner influence on patients propensity to
sue
How the patient feels about medical intervention
is key to their Treatment as a person, not a
procedure Understanding of the procedure and
its risks
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GP Non-Procedural
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GP Non ProceduralFailure to Diagnose
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GP Non ProceduralDelay in Diagnosis of Cancer
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GP Procedural excluding obstetrics
Unfair Dismissal
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GP Procedural with obstetrics
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Breast Cancer Claims

• of the finalised claims reviewed
• ? 77 - patients had previous breast problems
• ? 41 - initial mammogram was normal
• ? 41 - multiple GPs
• i.e. locums, other GPs in practice
  involved in care
• 27 - patients asked to return but did not
• 14 - patient returned but no FU of breast
  problem
• 9 - system to follow-up known malignancy
  failed

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Bowel/rectal cancer

• Of cases reviewed
• 40 - female 60 -
  male
• 80 - delay in diagnosis
• 20 - failure to diagnose
• 60 - presented with PR bleeding
• 40 - no screening despite known family history
• 20 - no proctoscopy
• 20 - long-standing abdominal problems
• 20 - usual GP away

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Failure to follow-up

• Of claims involving malignant cancers
• No clear follow-up of plan when patient moved
  interstate
• No clear plan for results ordered at hospital to
  be reviewed either there or by referring GP

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Risk Management Strategies The Practitioner
Looking at risk . .. Seeing opportunities
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System issues

• Do you have a flow chart for all patients who
  present with breast problems?
• Are you clear on what to do with a clinical
  abnormality and a normal mammogram
• Do you understand the difference between a
  screening mammogram and a diagnostic mammogram?
• Do you review cases with your local Radiology
  provider?
• Are you clear on the management of a breast lump
  in pregnancy or when the woman is breast-feeding
• Which breast lumps make you suspicious?
• Which breast lumps should make you suspicious?

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System Issues

• Do you have a clear plan to mange your patients
  when you are not in the office?
• Do you have a system of handover / follow-up?
• Do you know which patients you should recall?
• Which patients do you currently recall?
• Do you have information leaflets for common
  investigations or treatments?
• Do you explain what is going to happen to a
  patient when they are sent on to a specialist

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Conclusions for Practitioners
? There are influences out of your immediate
control. These impact patients, the courts and
government attitudes ? These influences may
increase the propensity to sue and do increase
the amount paid ? There are many influences
within your domain. Focus on your circle of
influence
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The MDAV Approach to Risk Management
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The objectives of the MDAV Risk Management
Programme

• Introduce Medical Practices to the discipline of
  risk management throughout all areas of their
  practice
• Reduce adverse experiences and the cost of
  medical malpractice

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Education, Tools and Support
Workshops/Seminars
Internal presenters and risk management
educators One hour to multi-day Series of
connected themes Practitioners and practice
staff Voluntary for some members and
compulsory for others Alliances with Colleges,
Divisions and AMA for content and delivery
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Education, Tools and Support
Practice Evaluation

• Graduated program - Ranging from self assessment
  (online support via MDAVs website) to compulsory
  practice Audits for some practices
• Potential stand alone service offering

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MDAV RISK MANAGEMENT PROGRAMME