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Patient Complaints and Post-Operative Complications

Posted By Administration, Thursday, April 20, 2017
Updated: Thursday, April 20, 2017

Do rude and disrespectful behaviors have an effect on patient safety? 


by Gerald B. Hickson, MD

 

Patients and their families are critical members of the health care team and are uniquely positioned to observe the behaviors of clinical team members. Organizations who listen will find that patients’ stories can be sources of valuable information that can promote improvements in care. 

"Study results remind me how important it is

to engage patients and families in our efforts

to promote safe care."

—Gerald B. Hickson, MD

 

Fifteen years ago, our Vanderbilt research team recognized that if patients’ unsolicited complaints were documented, coded, and aggregated, they reliably identified a small subset of physicians (2-8% by specialty) who accounted for more than 75% of malpractice claims and costs. Our early studies, however, did not answer an important question: Is high claims risk simply about making patients and families unhappy or is there something more?

 

In a study published in JAMA Surgery, we asked if patients who received care from surgeons associated with high numbers of complaints about perceptions of disrespect were more likely to experience complications from surgery than patients who were seen by surgeons who attracted few, if any, complaints.

 

We used data from the American College of Surgeon’s National Surgical Quality Improvement Program (NSQIP®) and our Vanderbilt Patient Advocacy Reporting System (PARS®), which uses unsolicited patient complaints to identify physicians with a high risk for malpractice claims. The study design allowed us to look at a surgeon’s complaints for 24 months prior to the target surgery and any postoperative complications in the 30 days post procedure. Seven medical centers that participate in both PARS® and NSQIP® contributed 817 surgeons and more than 32,000 surgical procedures to the study.

 

The analysis revealed that patients whose surgeons were associated with the highest numbers of complaints had almost 14% more postoperative complications when compared with patients seeing surgeons viewed as respectful, even when the analysis controlled for patient, surgeon, and operative characteristics. If extrapolated throughout the US (27,000,000 surgeries annually), failures to model respect and communicate effectively contribute to more than 350,000 additional surgical site infections, cases of sepsis, and urinary tract infections, representing more the $3 billion in additional costs with no way to calculate the magnitude of the impact on patients and families.

 

Study results remind me how important it is to engage patients and families in our efforts to promote safe care. Patients experience our dysfunctional systems and unprofessional clinicians. The question is, when they are willing to share, are we willing to listen, learn, and respond? Patients do not always describe their observations in "proper" medical language and as a result are too often discounted or ignored. Our results make it clear, however, that what is experienced and reported is valuable and serves to identify surgeons who have difficulty working with others contributing to surgical complications and excess malpractice claims risk. We suspect that our research team will identify similar findings in ICUs, emergency rooms, cath labs and wherever medicine is practiced.

 

Results also answer the question that our team has pondered for 20 years: Is high claims risk just about the random bad outcome and routinely making patients and families unhappy? The answer is no. It is not "just" about modeling disrespect toward patients. The same behaviors reported by families are also experienced by medical team members who can become distracted, lose situational awareness and willingness to speak up or ask for help when needed contributing to thousands of avoidable surgical and medical complications each year.

 

The good news is that our experiences in supporting interventions, with more than 1800 high-risk clinicians from our national partnerships, has taught us that most physicians modeling patterns of disrespectful behaviors (approximately 75%) just need to be made aware that they stand out (see Pichert et al. 2013). However, setting the stage to deliver “awareness” is critical and requires leadership that does not blink (rationalize) when the disrespectful surgeon is perceived to have special value. It also requires leadership that will commit to building the infrastructure to support professionals who are willing to deliver peer-based comparison data to help their at-risk colleagues pause and reflect on how their behaviors are experienced by others. The work is not for the faint of heart but is professional and aligns with the NPSF commitment to creating a world where patients and those who care for them are free from harm.

  

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Have you witnessed disrespectful behavior that you think contributes to the quality of care? Comment on this post below. Note: to post a comment you must be logged in. Register or log in.

 

Gerald B. Hickson, MD, is senior vice president for quality, safety and risk prevention and Joseph C. Ross chair for medical education and administration at Vanderbilt University Medical Center and a long-serving member of the NPSF Board of Directors. 

Tags:  disrespect  patient reporting  research 

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5/11/2017
NPSF Webcast: Improving Patient Safety in Primary Care: Strategies to Engage Patients and Families

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