How Physicians Insurance's Services Evolve With Changing Needs
James P. Campbell, MD
Chairman of the Board
One thing I have always admired about Physicians Insurance through the years is the company’s ability to address the needs that physicians and clinics care about at any given time. Only a responsive company—one that continually listens to members and develops projects to address their needs—can give members the resources they need, when they need them.
Our obstetrical simulation drills are a perfect example. We know from our evaluation data, validated by an increasing body of medical literature, that simulation drills improve communication and performance during emergency obstetrical procedures. Specific insights gleaned from OB teams where we’ve conducted drills over the past year are then integrated into drills at the next hospital.
For example, a simple practice such as physicians and nurses completing standardized documentation together arose as an idea during a recent simulation course and is now part of that hospital’s protocol. We have also incorporated the idea into course evaluation measures going forward. Participants are asked in a pre-course survey, “Is documentation completed by providers and nurses together?” In that way, the seed for improvement is sowed, to be further cultivated during the drills, as well as through follow-up evaluation forms and reminders. Thus, our simulation drills are evolving as a powerful tool to improve practice throughout the obstetrical community.
This fall a group of seasoned patient advocates, physicians, nurses, insurance executives, trial lawyers, and leaders from the Washington State Medical Association, Washington State Hospital Association, and Washington State Pharmacy Association gathered to discuss a goal they all believe in: improving patient safety. The group was convened by the University of Washington, Physicians Insurance, and the Foundation for Health Care Quality as part of the AHRQ demonstration project.
Together the trio launched the HealthPact Forum with the mission of transforming communication in health care. The HealthPact Forum is a platform to promote communication and transparency. The Forum also aims to open dialogue between the health care community and the general public and to support projects that foster communication and transparency in health settings, professional schools, and institutions throughout Washington State. The HealthPact Web site will serve as a clearinghouse for best practices on disclosure, patient safety, and support for health care providers.
It’s HealthPact’s unique group of stakeholders that makes it an agent for change. That’s because some of these individuals might find themselves on another day as opponents in a courtroom.
“Many have worked closely together, but they have also worked against each other,” says Dr. Tom Gallagher of the University of Washington. “HealthPact presents an opportunity for dialogue among health care providers and organizations, including regulators, attorneys, and patient advocates. We all have insights to provide about communication and transparency in health care. The lack of it has made health care more difficult, particularly when an unanticipated outcome occurs.”
HealthPact’s first success has been to pull all the stakeholders to the table. “Malpractice litigation is adversarial and nobody trusts the other side. Ideally, participating in HealthPact is one way to break through that lack of trust,” says Andrew Bergh, an attorney representing the Washington State Association for Justice. “There will always be cases where people don’t agree whether a medical mistake occurred, but at least we can strive to resolve disputes in an ethical and civilized way.”
Swedish Medical Center’s Chief Medical Officer John Vassall, MD, has high hopes for HealthPact and also serves on the HealthPact Forum’s Leadership Group. “At Swedish we’re promoting a culture of safety across our system and teaching physicians safety tools and techniques to implement a safe culture. One of our goals is to help physicians improve communication with their patients, including communicating about risk when obtaining informed consent.”
According to Dr. Vassall, good communication begins with shared decision making between patient and provider: “The conversation starts before an adverse outcome occurs. It’s better for patients to be in the position of understanding their risk and knowing what to expect in their care in order to receive an optimal outcome. Patients must also know what they can do to assure a good result. The more information patients receive up front, the better off they are.”
Still, as patient and Leadership Group member Brandelyn Bergstedt knows, there will always be unexpected outcomes (see “Why Communication Counts” on page 11). “When hospitals have patients who are upset, they tend to assume they have to fix everything in order to maintain a rapport with the patient. That isn’t always true; they can reduce the patient’s anxiety, fear, and mistrust simply by the way they communicate once they are aware of the mistake.”
The HealthPact Forum will begin offering semiannual meetings that train and engage participants in 2012.
As Physicians Insurance continues to participate in projects encouraging open communication and improved patient safety, I feel confident that our members will be part of this shift. Together, we will be prepared for the challenges of the changing health care environment—continually focusing on patients’ needs and strengthening health care in the Northwest.