Here Are 3 Areas With the Biggest Threats to Patient Safety in Health Care Settings

The 2019 Annual Patient Safety & Quality Industry Outlook report examined this year’s top risks to patient safety and hospital bottom lines.

The 2019 Annual Patient Safety & Quality Industry Outlook report from Riskonnect and Patient Safety & Quality Healthcare examines this year’s top risks to patient safety and hospital bottom lines.

According to 228 respondents in a February 2019 survey of health care providers, the most worrisome areas of risk were slips, trips, and falls (64%); health care-associated infections (58%); medication mix-ups (54%); workplace violence (34%); and antibiotic stewardship (32%).

Employee issues were also a concern, including the impact of adverse events on the clinicians involved, or “second victims,” and burnout, with 56% of respondents reporting their organization was slightly or highly ineffective at helping staff handle burnout.

In the area of patient engagement, large portions of respondents cited patient safety (90%), patient satisfaction (79%) and clinical outcomes (57%) as areas in need of improvement. Surprisingly, many also said their organizations were strong in those same areas: patient safety (40%), clinical outcomes (38%) and patient satisfaction (23%).

Other areas of concern include patient financial engagement, which 52% of respondents said was somewhat weak or very weak, as well as family engagement in patient care (37%), patient engagement in care (34%) and delivering what the patient values (26%).

Many respondents saw progress in the area of suicide risk, with 38% assessing their hospital’s efforts as highly effective and 43% as slightly effective.

Here are three areas that pose some of the biggest threats to patient safety in the health care setting:

1) Patient Engagement

Regarding patient safety culture program goals, 47% thought communication openness was the area most in need of improvement, followed by hospital handoffs and transitions (39%) and feedback and communication about errors (38%).

The report emphasizes the importance of patient engagement in reducing diagnostic errors and cites research that identifies four areas where poor clinician-patient relations contribute to diagnostic errors: clinicians ignoring or disregarding patient or family-member reports of symptoms or changes in patient status; disrespect of patients; failure to communicate; and manipulation or deception.

Recommendations to reduce diagnostic errors include: lifelong communication training for clinicians; incorporating communication skills, professionalism, and safety knowledge in certification and continuing medical education programs; systematic collection of patient observations of clinician behaviors; developing interventions to address patient reports of risky clinician behaviors; and including patient reports of diagnostic errors in training and patient-safety programs.

2) Clinician Support

Progress in the area of support for clinicians has been slow. While the percentage of respondents reporting that their organization lacks any second victim support program is down to 55% from 62% in last year’s survey, that is still more than half.

There were slight increases in respondents reporting that their organizations have a program in place (18%, up from 16% last year) or were exploring such programs (18%, up from 13%).

“Second victim” support programs were regarded as highly effective in helping nurses (14%), physicians (12% highly effective), other clinical staff (11%), care managers (11%), nonclinical staff (9%) and executive staff (9%).

Burnout is another major concern. A 2018 meta-analysis of 47 studies involving more than 40,000 physicians calls physician burnout an “epidemic” that is “associated with a higher risk of patient safety incidents, poor care, and lower patient satisfaction.”

Burnout was most common among critical care physicians (48%), neurologists (48%), and family physicians (47%), with women more likely to experience burnout than men (48% versus 38%), and those aged 45–54 range most likely to experience it (50%).

Burnout accompanied by symptoms of depression and emotional distress was associated with a twofold increase in risk of safety incidents. Respondents identifying as depressed reported being less friendly with patients (29%), less motivated to be careful when taking patient notes (24%), more likely to express frustration in front of patients (14%) and prone to errors they wouldn’t otherwise make (14%).

While 39% of respondents described their organization’s efforts to address staff burnout as slightly effective, only 5% called them highly effective, and a majority described them as slightly ineffective (36%) or highly ineffective (20%).

3) Hospital-Acquired Infections

Half of survey respondents reported their facilities were very strong in infectious disease surveillance and reporting, with slightly fewer reporting very strong health care-associated infection prevention (48%), sterilization and disinfection (41%), isolation (39%), and hand hygiene compliance (35%).

One of five respondents said their organization was somewhat weak or very weak in hand hygiene compliance, employee education and health, and isolation.

The report cites recent research suggesting that proper infection control practices could reduce hospital infections by more than half. Among the most preventable are bloodstream infections, a common and serious hospital infection that can cost $10,000–$20,000 to treat, and up to $40,000 if intensive care is necessary.

Respondents see progress in addressing suicide risk in hospitals, with a large majority reporting their organization is either highly effective (38%) or slightly effective (43%).

Looking Ahead

When asked their investment priorities in patient safety and quality innovation, 77% cited cyber security protection, followed by clinical communication platforms (70%), clinical test results notification systems (60%), automated clinical safety surveillance systems (59%), emergency notification systems (59%), and hand hygiene monitoring (58%).

Respondents see progress in risk management, with 45% reporting root cause analysis that was highly effective and 41% reporting slightly effective.

Risk assessments were seen as highly effective by 33% and slightly effective by 52%. Other risk management practices considered include hazard vulnerability analysis (30% highly effective/50% slightly effective), failure modes and effects analysis (27%/46%), patient tracers (31%/41%), system tracers (25%/47%), and enterprise risk management (21%/51%). &

Jon McGoran is a magazine editor based outside of Philadelphia. He can be reached at [email protected].

How a Carrier Partner Can Help Navigate a Challenging Management and Professional Liability Market

A combination of a choppy economy with increased claims frequency and severity could lead to rate increases in the Management & Professional Liability market.

By: Risk & Insurance | April 3, 2024

Rates in the management & professional liability (M&PL) markets were on the rise from 2020 to early 2023 and are now falling rapidly.

M&PL divisions manage a number of different insurance products including management liability (D&O), professional liability (E&O), employment practices liability (EPL), fiduciary liability policies, cyber, etc. In 2023 and into 2024, a big influence on the marketplace has been the extremely aggressive and softening public company D&O market.

Though these rates have been softening for management liability, that may change over the next few years as companies continue to adjust their business models motivated by economic uncertainty. Layoffs were up nearly 200% last year, Forbes reported, even as other recession indicators, like the inflation rate, improved. A recession could lead to an increased claim activity and force carriers to raise rates.

“Whenever there is a meaningful downturn in the economy, we tend to see claim frequency pop up,” said George Schalick, Jr., senior vice president of the Management and Professional Liability Division at Philadelphia Insurance Companies (PHLY).

With continued fiscal uncertainty, businesses potentially already burdened with pandemic-related claims should seek a carrier with a long history in M&PL products. They will provide much-needed risk management guidance and be better positioned to support their insureds during market fluctuations.

Why Insureds Might See an Uptick in M&PL Claims

George Schalick, Jr., Senior Vice President of the Management and Professional Liability Division, Philadelphia Insurance Companies

The current soft market might come as a bit of a surprise as it does not track with previous underwriting cycles and economic conditions. Afterall, many privately held and non-profit organizations struggled during the early days of the pandemic with shutdowns and rapidly declining revenues. But the Government assistance programs, like the Paycheck Protection Program loans, helped keep many afloat during the tough times.

“During COVID many organizations stopped doing business until they were able to sort out all of the health and safety challenges,” Schalick said. “They were forced to lock down, but then all the government assistance programs allowed them to keep people employed. The increased volume of claims we anticipated we would see coming from the lockdowns and restrictions that were imposed upon businesses in the U.S. didn’t manifest at first.”

“Just because there wasn’t an onslaught of reported claims at the beginning of the pandemic, doesn’t mean the circumstances that would give rise to a claim being reported didn’t occur. Courts and the judicial system were closed or slowed and now that they are back open, we’re starting to see the circumstances that occurred during the COVID lockdowns becoming claims today,” Schalick said. “Litigation is progressing.”

Added to the delayed pandemic litigation is a concern over newer claims that might be filed as the country inches toward an economic downturn. Though a recession was avoided in 2023, experts think a soft dip could occur in 2024, with 76% of economists saying there’s a 50% or less chance of an economic downturn this year — that almost always results in more management liability claims.

“During the Great Recession in 2008, we saw an almost immediate spike in claims because of the economic conditions and the pressure it placed on organizations. They were making personnel changes with significant belt tightening almost immediately.” Schalick said.

What’s in Store for M&PL Policy Rates in 2024?

Despite an uptick in claims and increased economic uncertainty, management liability rates haven’t increased, resulting in market-wide pricing levels that may not meet the increased pressure of rising settlements and jury verdicts.

“Rates are going the other direction and settlement values are not falling,” Schalick said.

The mismatch between rates, claim frequency and severity is, in part, because carriers experiencing the dramatic soft market in the public D&O market are seeking premium gain in the private and non-profit market.

“In the public company market, the rates have been decreasing significantly. The rates were increasing in the private, not-for-profit market, and rightfully so, but there’s a desire to supplement overall mid-size D&O for carriers who also write private not-for-profit, and they see that as an opportunity to aggregate premium,” Schalick said. “So the always competitive landscape in the private, not-for-profit market has dramatically increased in the last 18 to 24 months.”

Still, companies of all sizes and types should be concerned about management liability rates in the future. Legal system abuse is resulting in increases in both the amount of litigation and the size of verdicts plaintiffs are receiving.

Certain areas of the country are particularly vulnerable to this type of legal system abuse. As a result, insureds in these localities are likely to be vulnerable to rate increases.

“The environment is so positive for the plaintiff that forces premium increases so carriers are able to stay in that market long term,” Schalick said.

Why a Tenured Carrier Partner Can Help Insureds Navigate An Uncertain Market

It’s clear that insureds are facing an uncertain M&PL market over the next few years. Fortunately, carriers with a long history in the M&PL space will be there to offer stability.

Philadelphia Insurance Companies has been supporting this market for 35 years. PHLY is committed to offering long-term rate stability, even as economic and claims trends start to push premiums upwards. They have an appetite for all sorts of companies, large and small, for-profit and nonprofit alike.

“We’ve been at this game for a long time and are one of the most tenured underwriters in this space,” Schalick said. “We like to stay very consistent.”

PHLY has worked with both for-profit and non-profit on management liability policies. With dedicated M&PL teams throughout the company’s 13 regions, PHLY provides the support agents and brokers are looking for on behalf of their clients. The teams know their regions well and can respond to local trends. They’re also dedicated to making the renewal process as easy as possible for their partners and policyholders.

“We have real confidence in our results, so we focus a lot on making the renewal experience as painless as possible for all agents and insureds,” Schalick said.

The company is also investing in tools to help insureds avoid losses. Earlier this year, they launched a new online risk management platform, PHLYGateway, which offers resources for insureds on how to create an employee handbook and trainings on issues such as recognizing workplace sexual harassment and discrimination.

If insureds have questions, they can consult a Best Practices Help Line, provided via the platform. That way, they can get on the spot risk management guidance to help them prevent claims.

To learn more, visit: https://www.phly.com/mplDivision/managementLiability/default.aspx.

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Philadelphia Insurance Companies. The editorial staff of Risk & Insurance had no role in its preparation.