Caring for Kids Meant Promoting Best Safety Practices for This Risk Manager
Children’s National Medical Center (CNMC) was at a critical point in managing its litigation risks, and its medical malpractice captive was at risk of being underfunded.
For 2018 Risk All Star award winner Rebecca Cady, CNMC’s vice president and chief risk officer, that meant protection for CNMC’s clinicians was at risk — compromising the organization’s mission of caring for children.
“That’s really my motivation,” said Cady. “To do what I can to protect the people who work in this building so that they can focus on taking care of those kids.”
Cady brought litigation and captive management in house. A top issue was that leadership was not getting the critical information it needed to address problems before they could gain real traction.
In addition to a daily check-in call for safety, Cady’s team instituted a weekly C-suite leadership risk huddle for operational and clinical leaders, a bi-weekly huddle to update the CEO and a regular report to brief the board chairman.
This has eliminated unpleasant surprises for senior leadership and the board, said Cady, and raised awareness of how response time impacts risks and outcomes. CNMC now has the lowest rate of serious preventable patient safety events in its history, translating to averted professional liability claims totaling nearly $110 million.
“That’s really my motivation. To do what I can to protect the people who work in this building so that they can focus on taking care of those kids.” — Rebecca Cady, vice president and chief risk officer, Children’s National Medical Center
The key to achieving CNMC’s level of timely and transparent level of communication, said Cady, is to “hard-wire it into the process and make sure that the pathways are clear.”
Cady also brought clinicians into the loop. Unlike private practice physicians, CNMC’s clinicians didn’t write monthly checks to pay for their professional liability premiums. So costs were out of sight, out of mind. There was a disconnect between the risks they faced and their perceptions of how they personally impacted the organization’s litigation risk.
“No doctor wants to get sued. But the fact that they’re not writing that [premium] check every month means maybe they’re not thinking about it as much as they would,” said Cady.
Cady’s team launched a physician malpractice allocation program, which sets premium for physicians at the division level, and gives CNMC the ability to reward or penalize divisions based on cases filed.
This change helps clinicians “understand that they have some ability to influence the number — that their safety behaviors on the front end ultimately do impact what the organization pays in malpractice.”
The changes implemented by Cady and her team have resulted in a net positive movement on reserves of over $100 million over five years. Program management expenses, including attorneys’ fees, have dropped by 47 percent.
In some organizations, observed Lisa Scafidi, the organization’s director of clinical risk management, “there’s clinical risk management, there’s litigation and the captive, and they live in silos even when they’re in the same department. But there’s more of a fluidity in the way these things interact now [at CNMC] and there’s a lot of benefit to that.” &