A New Role for Quality in Medical Liability Reform

The statewide initiative will look at how a large malpractice insurer, physicians, and private hospitals can work together when there has been a medical injury to provide patients with fast and fair compensation, Gallagher says.

It will be a real breakthrough, he adds, to try to extend the work on disclosure and compensation that has been done in some of the large self-insured settings—such as academic medical centers—to the private hospital environment.

In the self-insured setting, the physicians and a hospital have the same malpractice insurer. But, in the case of a private hospital—where the physicians and hospital have different insurers—both bodies can be at odds with one another, Gallagher adds. "It makes it much more difficult to figure out how can we together make a fast, fair offer of compensation to the patient."

While it's important to avoid injuries in healthcare whenever possible, "it really adds insult to injury when we can't provide the patient with a good explanation and an apology," he says. "And then things get even worse if the patient has financial needs as a results of the injuries that we can't meet."

"I think the stakes are really high to get this right," he says.

Another aspect of this process is to realize that communication with the patient can be an important part of improving quality, he adds. If something goes wrong and "you have an open and honest conversation with the patient about what took place, oftentimes the patient will have observed things about the injury that is really helpful information," he says.

Without talking with a patient, important information that could be lost that might be used for preventing other error or adverse events, he says. But they also are learning that when they encourage openness around injuries with patients, it has a spillover effect in the institutions and promotes transparencies in other areas—such as adverse event reporting.

"I think people will start to learn that the link between disclosure and improving the quality is a strong and important one," he says. "It's definitely the right direction we're headed."