Linda Harvey, RDH, MS
Risk Management issues can easily derail the best practice management program. Couple this fact with results from a National Patient Safety Foundation poll, where 42% of respondents believed they had been affected by a medical mistake, either personally or through a relative or friend.
Patient complaints to licensing boards continue to rise, with fines and penalties easily exceeding $10,000. This trend indicates the systems and processes we have had in place for both risk management and patient safety have not met the needs of our patients or our clinicians.
Is your practice as safe-guarded as you would like? It's never too soon to incorporate platinum risk management strategies that can safeguard not only your practice, but the profits you have worked so hard to produce. Read on for answers to some commonly asked questions about how to ensure you have risk management strategies in place in your practice before you need them!
Q: What is the most common cause of patient complaints to a dental board about their dentist or the dentist's staff?
A: Patients tend to file complaints against their doctor or staff when they feel their concerns or complaints aren't being heard. They may not be happy with the quality of their care, or the type of care they received. And since they are likely to have made a significant investment in their treatment, the results can be costly when they are unhappy. They want restitution. They want the doctor to 'pay' for not listening to them.
Q: Are damages covered by a dentist's liability insurance?
A: Not always, it varies by policy. Not all liability carriers cover complaints made to the licensing board against a dentist's license because the complaint does not constitute a lawsuit. Even if some of the costs are covered, other out-of- pocket costs for the dentist can still be enormous. In Florida, for instance, the maximum penalty is $5,000 per violation, but the dentist also pays for the cost of being prosecuted, and for any cost associated with required CE courses relating to the complaint. When facing any type of legal proceedings, it is wise to have legal representation. This may be an out-of-pocket expense in addition to any time spent away from patient care while attending to the details of the complaint.
Q. You say there are six main areas in a practice where there are underlying risk management considerations. What are they?
A. They are:
- Operational. Risks resulting from your core business practices including clinical risk. This category includes all the critical operational aspects of your practice, such as patient records, coding and billing practices, and office policies and procedures.
- Financial. Risks associated with the ability of your practice to make money and remain fiscally sound. What do your monthly, quarterly, and yearly financial reports tell you? Have you identified any trends regarding overhead, billing, or collections that need attention?
- Human capital. Risks related to your staff, encompassing recruitment, training and maintenance of these individuals. With an ever-changing workforce, employee-related risks continue to grow. Consider possible employee-related risks ranging from property or identity theft to embezzlement or employment-related lawsuits within your practice.
- Strategic. Risks associated with external events and trends that can impact the growth and value of your practice. Does what is happening on Wall Street affect your practice? How? What about trends in your local dental community?
- Legal and Regulatory. Risks associated with state and federal rules, regulations, and statutes affecting dentistry. If an auditor, state regulator, or federal agent appeared at your doorstep, is your documentation up-to- date? How will you prove you are in compliance?
- Technology. Risks resulting from rapidly evolving technologies and equipment, biomedical products, computers, or teledentistry. Is newer always better? Consider the impact that new piece of equipment or software will have on your practice (beyond the bottom line). Poorly maintained and operated equipment can provide a costly lesson. In the case of electronic equipment and devices, security measures must be addressed.
Adapted from Ching, W.R.H. 2004. Enterprise Risk Management: Laying a broader framework for health care risk management. In R. Carroll, (Ed) Risk Management Handbook for Health Care Organizations, 4th Ed. (pgs. 3-14). San Francisco, California Jossey Bass.
Q. You recommend that practices implement a 'no losers' policy to ensure a culture of safety. What do you mean by that?
A: A 'no losers' policy refers to the fact that everyone in the office should feel they are on the same team, and that no one should feel like a 'loser' when an unexpected incident occurs. The object of developing a culture of safety is not to place blame on each other, but to develop teamwork strategies that translate into patient safety strategies as well. By the same token, a team member should not be made to feel badly for identifying an opportunity for improvement within the practice. Everyone should feel safe within the team environment to freely admit a mistake as well as contribute ideas for improving patient care. The culture and philosophy within a practice ultimately drives risk management and patient safety endeavors.
Q: What other Platinum Strategies do you recommend?
A: Proper documentation is key. For instance, subtle differences in the words we use when documenting treatment can make a huge difference in successfully defending a patient complaint, if it ever comes to that point. But we have to teach our team members how to capture and document this information correctly and consistently. Just because lengthy progress notes are kept doesn't mean they are of proper quality.
Communication patterns should be consistent as well so that all team members are conveying the same message. Your team should use the same phrasing and wording when discussing treatment so that patients get consistent and coordinated explanations. This is even more important if a patient related mishap or incident occurs. Good communication skills also help us pick up on subtle messages patients may be trying to tell us - the kind that lead to complaints when they go 'unheard'.
Remember, when a patient makes a complaint to the licensing board, regardless of how frivolous, the dentist will be required to provide a copy of his/her records to a peer review panel. This panel may decide the treatment met the standard of care, but the documentation is below par. Without adequate and consistent documentation, the chances of disciplinary action skyrocket.
About the Author
Linda Harvey, RDH, MS teaches dentists how to protect their million-dollar practices through effective risk management and patient safety. She works with dentists in multiple states who have been reprimanded by the dental board. Linda presents, writes and consults in the areas of risk management, patient safety, health literacy and regulatory compliance including HIPAA and employment law. Her company was the first private company approved by the Florida Board of Dentistry to provide risk management, record keeping and ethics courses in disciplinary cases.
Linda holds licensure in both healthcare risk management and dental hygiene. She combines these unique credentials to show clinicians and other practice management consultants how they can help clients significantly reduce risk and legal liability.
You can reach Linda by email at Linda@LindaHarvey.net, or visit her website.
