Executive Summary
Patient satisfaction can directly influence the risk of malpractice litigation. Expectations must be managed from the outset to avoid misunderstandings.
- Physician practices acquired by hospital systems should be assessed for satisfaction programs.
- Patients who feel ignored by physicians or hospitals will seek an attorney to listen to them.
- Determine a patient’s expectations from the start, and ensure they are reasonable.
Patient satisfaction is more than just a touchy-feely goal for a healthcare institution. Keeping patients satisfied and acting on their complaints can have a direct impact on risk and liability exposure.
Evidence supports that happy patients don’t complain, and patients who understand a complication of care is not an “unexpected” result don’t sue, notes Lee McMullin, CPHRM, senior risk management and patient safety specialist with the Cooperative of American Physicians, a nonprofit in Los Angeles that represents the interests of healthcare providers in California. McMullin also is president of the Southern California Association of Healthcare Risk Management.
The root of patient complaints is the failure to recognize and manage patient expectations, he says. Many complaints and malpractice lawsuits are rooted in the patients’ failure to understand the expected results and risks about their healthcare, he notes. For that reason, avoiding dissatisfied patients and lawsuits depends on assessing the patient’s level of understanding and expectations for the proposed surgery or procedure.
When expectations are not met, the assumption is that the unexpected result is the product of error versus a realized risk and complication of treatment. This situation places the burden on the healthcare team to explain or “disclose” in a manner consistent with the patient’s level of comprehension why his or her expectations are unrealistic or why you are not negligent with your care. That’s never an easy conversation, so eliminating that misunderstanding upfront is a better strategy.
Physician practices
The notions of patient satisfaction and expectations come into play more acutely with physician practices, McMullin says.
The reason is that the interchange is more personal and patients look to the physician as the captain of the ship when anything goes wrong, he says. With hospital systems integrating more physician practices, McMullin cautions that risk managers might be unfamiliar with the physician side of the equation when it comes to patient satisfaction and expectations.
“When you are acquiring a physician-based practice, it is key to evaluate whether there is a system in place there to pick up on patient satisfaction issues and complaints,” he says. “Small little issues can smolder and become large problems. Remember that there are people out there who are very skilled at making mountains out of molehills. They’re called attorneys, and they’re very good at running the excavator and adding more dirt on top of the molehill.”
McMullin suggests looking at these three potential problem areas in a physician practice:
- Does it have a system in place to identify and capture patient complaints?
- Is the staff encouraged to report problems and negative patient comments they observe or receive?
- Do staff have the necessary social skills and experience in complaint resolution?
McMullin notes that many staff members see their role as “running interference” between the doctor and the patient to protect them from unnecessary phone calls or “troublesome” patients.
“It is not uncommon to find staff members who are very well-intentioned, valuable members of the team, who think they are doing the right thing by being alert for unhappy or needy patients and steering them away from the boss,” McMullin explains. “Such notions actually propel you into the fast lane for legal grief. Patients who learn their doctor will not listen will find an attorney who will,” he says.
If managing patient expectations is the means of decreasing patient complaints, then consent is an important aspect of expectation management, McMullin says.
The consent discussion has evolved to being the most crucial event in managing a patient’s care. An intelligent assessment of the patient’s understanding of the expected results and its risks in the pretreatment phase is the foundation for managing any complaints that follow, he says. The failure to embrace this concept means an increased risk of facing a lawsuit.
Develop and encourage a patient-centered culture in which patient safety includes managing patient expectations and the preservation of patient satisfaction and customer service, McMullin advises. Consider using patient satisfaction surveys as a tool to measure the effectiveness of your efforts and identify ways to improve what you do.
Manage expectations from the outset, McMullin says. That process starts with determining whether your facility and professionals can provide what the patient is looking for. If the patient goes to a podiatrist complaining of a headache, the doctor should make clear right away that he or she is not the right person for the job. Similarly, patients who expect more than can be reasonably expected or promised should be counseled clearly from the start.
“If they walk in expecting something you can’t do, or an outcome you can’t guarantee, stop everything and make that your only focus until they have a better understanding,” McMullin says. “If you breeze by that and go on with your patient care, you’re setting the patient up for disappointment and frustration that will be taken out on you.”
