UIC receives $3M grant to evaluate comprehensive process for responding to patient harm events

The University of Illinois at Chicago's Institute for Patient Safety Excellence has received a $3 million grant to evaluate its comprehensive process for responding to patient harm events at nine other Chicago area hospitals.

The demonstration project, funded by the U.S. Department of Health & Human Services' Agency for Healthcare Research and Quality, is part of the patient safety and medical liability initiative announced by President Obama last year.

Few hospitals disclose medical errors to patients when harm occurs. UIC physicians and health care researchers were among the first to devise a detailed process for responding to patient-safety events. That process, known as the Seven Pillars, has been in place at UIC's medical center and its affiliated health clinics since 2006.

The process outlines seven critical elements to improve patient-provider communication, learn from mistakes, and ensure timely and equitable resolution when patients are harmed -- and thereby reduce frivolous lawsuits and medical liability costs.

The Seven Pillars are event reporting, investigation and root cause analysis, communication and disclosure, apology and remediation, patient safety and systems improvements, data tracking and performance evaluation, and education and training.

"Our method puts patients first, and we believe that the best way to get a handle on medical malpractice is by improving patient safety throughout the institution," says Dr. Timothy McDonald, principal investigator of the project and chief safety and risk officer for health affairs at UIC. "It's really a program about changing the culture in hospitals and our relationships with patients."

Even at the safest institutions, patient harm may still occur. Having a process for maintaining communication when harm occurs can be very effective in avoiding unnecessary litigation, McDonald says.

"In the event that inappropriate care has caused harm, it's important to settle those cases in a principled manner, in a reasonable amount of time, where the money goes to compensate the patients and families and not the legal system."

The grant-funded project expands UIC's program to six hospitals in the Resurrection Health Care System, two hospitals within the Vanguard Health system, and Mount Sinai Hospital.

The hospitals will be randomly assigned to phase in the process over a three-year period, allowing researchers to analyze the feasibility and effectiveness of the program in improving patient safety and reducing medical liability.

Researchers will measure the number of adverse event reports, (including near-misses and unsafe conditions), the number of reported significant adverse events, the patient safety culture, the number and quality of disclosures, the number of claims, the time to settle, the cost of malpractice insurance, and the proportion of settlement received by the patient or family.

An evaluation of Seven Pillars within the UIC health system found that, when compared to pre-intervention levels and trends, the process succeeded in increasing the number of adverse event reports submitted to risk management, increasing the number of communication consults offered to patients and families after harm events, increasing the number of peer reviews for clinicians, and decreasing the number of claims made against the health system.