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Perspectives on Safety > Interview
High-Risk Physicians and Disruptive Behaviors, December 2009
Gerald B. Hickson, MD, is one of the world's leading experts on physician behavior and its connection to clinical outcomes and medical malpractice. He is a Professor at the Vanderbilt University School of Medicine, where he is also the Joseph C. Ross Chair in Medical Education and Administration, Associate Dean for Clinical Affairs, Director of the Vanderbilt Center for Patient and Professional Advocacy, and Director of Clinical Risk and Loss Prevention. We asked him to speak with us about high-risk physicians and malpractice.
Perspectives on Safety > Annual Perspective
with commentary by Rachel J. Stern, MD, and Urmimala Sarkar, MD, 2018
Patient engagement is widely acknowledged as a cornerstone of patient safety. Research in 2018 demonstrates that patient engagement, when done correctly, can help health care systems identify safety hazards, regain trust after they occur, and codesign sustainable solutions.
Poll: Many Sick Americans Experience Significant Financial Problems and Report Their Care is not Well-Managed.
Princeton, NJ: Robert Wood Johnson Foundation, National Public Radio, and the Harvard School of Public Health. May 21, 2012.
This report describes findings from a poll that investigated how cost of care and health insurance affect patients' experiences of health care quality and safety in the United States.
Journal Article > Study
Pichert JW, Moore IN, Karrass J, et al. Jt Comm J Qual Patient Saf. 2013;39:435-446.
A recent Australian study showed that a small number of doctors account for a disproportionate share of complaints by patients. These physicians are more likely to engage in disruptive behavior and be the subject of a malpractice lawsuit; however, system-level solutions for addressing poorly performing physicians are lacking. This study reports on the outcomes of a peer feedback and coaching program for physicians who had received multiple patient complaints and were therefore considered at high risk for malpractice lawsuits. This program, which was described in a 2009 AHRQ WebM&M interview, consists of a tiered approach that relies on feedback of patient complaints accompanied by one-on-one counseling by trained peer clinicians. Among more than 370 high-risk physicians who received coaching, nearly all responded professionally to the feedback, and almost two-thirds were considered to have responded appropriately to feedback over an average of 2 years of follow-up. Although disruptive and unprofessional behavior has long been tolerated in health care despite the safety risks, this innovative program demonstrates that this problem can be successfully addressed.
Journal Article > Study
Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia.
Bismark MM, Spittal MJ, Gurrin LC, Ward M, Studdert DM. BMJ Qual Saf. 2013;22:532-540.
Although most patient safety efforts focus on identifying and addressing flawed systems, individual clinicians who cause recurrent problems—either through substandard clinical performance or overtly disruptive behavior—must be addressed as well. This analysis of an Australian national database revealed that just 3% of physicians accounted for nearly half of all complaints filed by patients, and relatively simple characteristics (including physician gender, clinical specialty, and number of prior complaints) predicted the likelihood that an individual clinician would be the subject of future complaints. These data, combined with prior research connecting medical school behavior to the risk of future disciplinary action, provide a means for regulatory authorities to predict problematic behavior by clinicians and point the way toward system-level solutions for problem doctors.
Journal Article > Commentary
Mollon D. J Adv Nurs. 2014;70:1727-1737.
This commentary explores safety from the perception of hospitalized patients. Review of the literature identified 40 attributes, including trust, being cared for, and staff competency, as elements that contribute to a patient feeling safe. The author uses constructed cases to illustrate how patient-centered care can improve outcomes.
Meeting/Conference > Canada Meeting/Conference
Canadian Patient Safety Institute. October 8–9, 2019; Sheraton Hotel Newfoundland, St. John's, NL.
This conference will share care improvement experiences of providers, policymakers, and health care executives from the four Atlantic Canadian Provinces. Topics covered will include patient engagement, staff well-being, the role of technology and innovation in health care, and patient safety measurement. Jeffrey Braithwaite is a featured speaker.