The New Health Dialogue

The grants that President Obama authorized for new approaches to malpractice and patient safety -- including variants of the "disclose and apologize" model -- were awarded earlier this month. (See the full list here). One of the grantees was the University of Illinois team we wrote about both on the blog and for Miller-McCune magazine. Dr. Tim McDonald helped us understand some of the technical and legal barriers to moving toward an early disclosure system. It's a lot easier in an academic medical center where the doctors, nurses, hospital are all covered under the same malpractice policy, it's far more difficult in community settings where the doctors aren't hospital employees and a half dozen insurers with different economic interests and philosophies can be involved in a single case. We also came to understand it's not just the "apology" that matters, it is the commitment to identifying, analyzing and most importantly fixing problems that can lead to patient harm. The Illinois project attempts to go to the heart of this problem, taking the model from the university into community hospitals.

A couple of the grantees look at perinatal patient safety -- right before and after childbirth, a high risk for malpractice suits. One looks at malpractice in the outpatient setting.

One of the grantees, New York Judge Douglas McKeon was profiled by the AP's Ricardo Alonso-Zaldivar. Judge McKeon has educated himself on medical practice -- and medical malpractice -- and developed a curriculum for other judges. He created what he calls “judge-directed negotiation.” He is now bringing five NY hospitals into a pilot program building on the early disclosure model. He does a mix of negotiation, and a variant of a "health court" (where specially trained judges preside...read more here and here). Patients and families always have the option of going to a standard jury trial.

The Agency for Healthcare Research and Quality also awarded 13 smaller planning grants to health systems working on ways of reducing medical injuries and improving safety. Some are focusing on how to create "safe harbors" so that doctors who really do act according to clinically-valid, evidence-based guidelines can have liability protection if something goes wrong, even if they do practice good medicine. Others are working on "shared decision-making" between patients and doctors.