Include Office Staff In Cutting Errors

Risk Management Should go Beyond Physicians and Nurses
Ann Whitehead
awhitehead@CAPphysicians.com

While a patient’s overall level of satisfaction depends largely on his or her interactions with the physician, in the medical office setting, the physician’s office staff plays no small part in this process.   

It is commonly known physicians rely heavily on their office staff to manage many important functions.  Experience has demonstrated that staff also has a significant influence over both patient safety and patient satisfaction.  Patient satisfaction and patient safety are two important concepts which can reduce medical liability in an office practice and promote good patient outcomes.  

According to research published in the Journal of the American Medical Association, the risk of claims in the physician office appears related to any or all of the following:  patients’ unhappiness with physician-patient interact, access, care or treatment that does not meet expectations, and communication.   Many lawyers and claims staff will tell you that it is a well-known principle that happy patients do not sue their doctors.  Patient experience directly correlates to how the patient feels about the physician.  Office staff plays an integral part in how the patient perceives the physician and his/her office staff.  That is why communication and follow through are extremely important principles for office staff to understand and practice.

In 2009, a review of closed professional liability claims data showed that 52% of all paid medical malpractice claims involved events in the outpatient setting, and two-thirds were claims involving major injury or death. Research over the last ten years has shown that some of the most widely documented ambulatory errors include:  

  • Medication errors - prescriptions for incorrect drugs or incorrect dosages 
  • Diagnostic errors -missed, delayed and wrong diagnosis 
  • Laboratory errors -missed and delayed tests as well as errors in patient follow-up on test results 
  • Clinical knowledge errors -knowledge, skill and general performance on the part of clinicians 
  • Communication errors - doctor-patient communication errors, doctor to doctor and other miscommunications in the office 
  • Administrative errors - errors in scheduling appointments and managing patient records.   

Utilizing the above information, five out the six categories (excluding clinical knowledge which usually relates to licensed healthcare providers) pertain to errors usually caused by a lack of sufficient office systems.  Improvement in each of these categories of error can occur in the office practice by providing concentrated staff education in specific areas.  Error prevention is attained through staff understanding of their roles and responsibilities in each area of liability.    

Historically, risk management education has targeted physicians and hospital staff.  However, over the years the importance of educating medical office staff has been brought to the forefront.  A risk management education program created specifically for medical office staff can promote and improve patient satisfaction, reduce liability and improve patient outcomes.  There are six areas of targeted  education to office staff which will improve their understanding  basic principles related to the care provided in a physician’s office practice.  The six areas of concentration include:

  • Informed Consent 
  • Medication Management
  • Effective Office Communication
  • Patient Education
  • Tracking and Recall 
  • Medical Record Management

Training in each of the above areas will provide staff with a baseline understanding of why communication and established office systems are extremely important in the medical practice setting.  The goal of education in each of these areas is to motivate everyone in the office practice to improve patient safety and patient satisfaction.  It is important that each think of themselves as having a significant role in preventing patient error.  Each should think of themselves as a risk manager.  

The ultimate goal of a trained medical practice office staff is to provide safe care and to improve the quality of the patient experience.   The over-riding philosophy should be….. “Everyone is a Risk Manager.”

Ann Whitehead is vice president of risk management and patient safety with the Cooperative of American Physicians in Los Angeles. This is the first in a series of articles.