HEALTH INDUSTRY ONLINE - A Strategic Approach to Handling Adverse Outcomes

Research on why people sue hospitals and health care professionals has revealed that the manner in which an adverse outcome is handled can determine whether it will result in a claim or litigation. ¹ An inefficient, inadequate and insensitive approach to handling an adverse outcome will increase dissatisfaction, exacerbate trauma, and damage the relationship between the physician and the patient/family. Such is a recipe for lawyers and litigation. Conversely, when adverse outcomes are handled strategically, effectively, and respectfully, the chance of those outcomes becoming malpractice suits can be greatly reduced.

Some researchers have indicated that malpractice risk has less to do with clinical and technical skills, and more to do with interpersonal skills. "Risk seems not be predicted by patient characteristics, illness complexity, or even physicians' technical skills. Instead, risk appears related to patients' dissatisfaction with their physicians' ability to establish rapport, provide access, administer care and treatment consistent with expectations, and communicate effectively."² Therefore, to reduce malpractice risk, health care providers would be well served to focus on the development of interpersonal skills that may be useful in handling an adverse outcome and preventing it from becoming a malpractice suit.

The following are five strategic ideas for handling adverse outcomes based on the literature referenced above:

1. Embrace the opportunity to manage the moment.

The first step in handling an adverse outcome is to embrace the opportunity to greatly reduce the trauma to a patient/family. After an injury, a patient/family needs more care and support, not less. Thus, health care providers should resist the natural urge to distance themselves from a patient/family in the face of an adverse outcome. Ignoring a patient/family after an adverse outcome can be distressing and a cause of increased trauma and dissatisfaction and may be a powerful stimulus to consult with an attorney and pursue legal action. On the other hand, taking control of the moment and staying connected with the patient/family after an injury can be a source of comfort, assurance, and hope. A health care provider with strong interpersonal skills can have enormous influence on a patient/family following an adverse outcome.

2. Communicate carefully and effectively.

Careful and effective communication with a patient/family is the key to preventing adverse outcomes from becoming malpractice suits. One of the maxims of communication is that "You cannot not communicate." Accordingly, a health care provider's failure to communicate with a patient/family following an adverse outcome is perhaps one of the strongest messages that can be sent and may compel consultation with an attorney. Health care providers should maintain open lines of communication with a patient/family and make strategic decisions on the substance and process of the communication. For instance, if a patient's concern or complaint is groundless, a comprehensive and sympathetic explanation can be therapeutic.³ If a disclosure and an apology are warranted, careful delivery can often be enough to restore satisfaction with the health care provider even though the outcome was less than desired.

3. Go below the line.

ISSUES
INTERESTS

As a result of each adverse outcome, issues and interests arise. Issues are concrete and identifiable concerns that must be addressed before patient satisfaction can be restored. Interests are intangible and abstract needs that drive people to take certain positions and must also be satisfied. Following an adverse outcome, a strategic health care provider will distinguish issues from interests and "go below the line" and focus on interests. By doing so, he or she may discover that which is very "real" to the patient/family, and thus, be empowered to respond to the adverse outcome in a way that the patient/family will find sufficient. For example, a patient's interests may include a desire for an explanation, an apology, or personal responsibility. At times, such interests can be satisfied without a health care provider or his or her insurer providing monetary compensation to the patient/family.

4. Employ the law of likability.

People are generally less likely to be adversarial with those they like. Being likable greatly increases the influence one can have on other people. Several studies have examined the interpersonal skills of physicians who have had a high number of malpractice suits filed against them. ⁴ Patients reported that these physicians would not listen, were rude, and did not show respect.⁵ Conversely, Levinson et al found that physicians without malpractice claims provided more orienting and facilitating comments and used more humor in their interaction with patients.⁶ Therefore, maintaining rapport, being personable, offering praise, and expressing sympathy following an adverse outcome can go a long way in preventing a malpractice suit.

5. Seek reconciliation.

When handling adverse outcomes, the goal of the strategic health care provider should be reconciliation, that is, to not only resolve the conflict, but also to restore the relationship of the people involved. "[Health care providers] should ensure continuity of care and maintain the therapeutic relationship."⁷ A broken relationship between the health care provider and patient/family following an adverse outcome is likely to increase the risk of a malpractice suit being filed.

The strategic ideas presented above involve interpersonal skills that are most successfully developed through training and practice. Strasburger seeks to serve health care industry by offering intensive training to health care providers on these interpersonal skills, handling adverse outcomes, and strategic claims resolution.

¹Charles Vincent, et al., Why Do People Sue Doctors? A Study of Patients and Relatives Taking Legal Action, 343 The Lancet 1609 (1994); Gerald B. Hickson et al., Factors That Prompted Families to File Medical Malpractice Claims Following Perinatal Injuries, 267 JAMA 1359 (1992).
²Gerald B. Hickson, et al., Patient Complaints and Malpractice Risk, 287 JAMA 2951 (2002).
³Charles Vincent, Understanding and Responding to Adverse Events, 349 N. Engl. J. Med. 1051, 1054 (2003).
⁴Gerald B. Hickson, et al., Obstetricians' Prior Malpractice Experience and Patients' Satisfaction with Care, 272 JAMA 1583 (1994); Hickson, et al., 267 JAMA at 1359-1363.
⁵Hickson, et al., 267 JAMA at 1359-1363.
⁶W. Levinson, et al., Physician Patient Communication, 277 JAMA 553, 553-559 (1997).
⁷Vincent, 349 N. Engl. J. Med. at 1054.