Distracted Doctoring by Peter J. Papadakos & Stephen Bertman

Author:Peter J. Papadakos & Stephen Bertman
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

 Impact on documentation and coding

 Impact on utilization efficiency (LOS/resource efficiency/DC planning)

 Impact on quality

 Impact on productivity and efficiency (down time/waste/delays)

 Communication inefficiencies ($4 million 500 bed hospitals)

VI. Risk management/malpractice: $521,560/lawsuits/fines: $25,000–$100,000

On one level disruptive behaviors have been shown to have a significant negative impact on nurse satisfaction and retention [44]. Replacing a nurse can cost the organization anywhere from $60,000 to $100,000 for recruitment, training, and secondary opportunity costs [45]. When it occurs in a public arena, disruptive events can also lead to patient dissatisfaction which can negatively impact HCAHPS scores and other patient satisfaction pay for performance initiatives which can have a negative effect on reimbursement. Then there is the spillover effect on hospital reputation which may impact market share and contract negotiations.

From a patient care perspective, the biggest concern is the occurrence of preventable medical errors or adverse events [39, 46, 47]. In addition to waste, duplication, and inefficiencies in management, lack of communication and collaboration can lead to task failures that result in medication errors, infections, delays in treatment, and other serious medical conditions which can increase lengths of stay and accrue significant non-reimbursable costs of care. The Joint Commission states that more than 50% of adverse sentinel events can be traced back to human factor issues and/or failures in communication [48, 49]. In response to the concerns about the impact of disruptive behaviors on patient safety in 2010, the Joint Commission added a new leadership standard requiring hospitals to have a disruptive behavior policy in place and to supply support for its intent as part of the leadership accreditation standards [50]. In order for hospitals to receive Medicare reimbursements, they need to pass the accreditation survey requirements [51].

From a compliance perspective, noncompliant behaviors that adversely impact coding and documentation requirements, nonadherence to utilization protocols, and/or not following best practice guidelines, policies, and procedures can all have a significant negative economic and quality impact on patient care outcomes. It is estimated that the average yearly cost for a midsize hospital due to communication deficiencies is $400,000 [52].

From a risk management perspective, issues can arise from not only the occurrence of medical errors or adverse events, but other issues can be related to poor compliance, poor communication and collaboration, impeded information transfer, neglect, failure to respond, and/or poor patient satisfaction. More egregious cases can lead to litigation. Time, preparation, and malpractice awards can result in significant dollar amounts with average malpractice settlements averaging above a half a million dollars [53–56]. In California there is the additional penalty of hospital fines (ranging from 25,000 to 100,000) for the occurrence of significant adverse events [57].

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