Safety Net: Recent Episodes
CRICO
Protecting Providers. Promoting Safety. We've got you. Our Safety Net podcast features clinical and patient safety leaders from Harvard and around the world, bringing you the knowledge you need for safer patient care.
Hospital birthing center uses a teams-based protocol to honor patient’s wishes and focused communication tactics among providers and with patients.
Defendants in the Harvard medical community have a new way to learn about the legal machinery and personal coping strategies they’ll need to be good participants in their defense. Listeners learn how a leading edge litigation preparation video program was incubated through CRICO, with guests Gita Pensa, MD and CRICO’s VP of Claims, Beth Cushing, JD.
What can you say after 45 years defending doctors, nurses, and hospitals in the Harvard medical community? A lot. Defending providers in court requires something different in 2026 than what prevailed in the 1980s, according to John Cassidy, who is retiring as senior partner at Ficksman and Conley. He shares his wisdom and insights for success in medmal defenses today and the future.
Progress in the work to solve a problem that threatens all providers and their patients: doctors often don’t seek mental health care because they fear the impact on their careers.
Communication errors in medmal cases are expensive and becoming more frequent among patients and providers. A new data report from Candello in the Harvard medical community looks at the increasing role played by communication failures, and how more complicated care in the outpatient setting means more complicated communication between providers and patients.
If a clinician is sued for medical malpractice and the case never goes to trial, they dodged a bullet right? A physician defendant shares what it was like to be sued, and going through all the ups and downs of defending himself against charges of negligence before the unexpected happened. His patient dropped the case just before trial.
For primary care clinicians, a top risk area is related to allegations of delayed diagnosis of cancer. Data in the Harvard system show that the top three cancers in primary care litigation are prostate, lung, and breast cancer. Harvard’s Marc Garnick, MD is a national expert on prostate cancer and liability sharing how to communicate with patients about risks and benefits of testing and interventions to minimize allegations of negligence.
A discussion with two legal experts in the Harvard system about why depositions are critical in a medical malpractice lawsuit. Attorneys Lisa Wichter and Alex Terry use their courtroom experience to explain how affect, demeanor, and preparation can change case outcomes.
In a review of Candello’s database of claims from malpractice insurers across the country, documentation failures emerged in one out of every five medical professional liability cases. They are also much more likely to close with a payment with higher than average dollar amounts.
Investing in patient safety programs not only helps patients, but also prevents large payouts for hospitals. And we can measure it.
Researchers looking for malpractice risks with virtual visits were surprised to learn that teleradiology was leading the way in professional liability claims over the past 12 years. Virtual office visits didn’t show up in the malpractice claims data, but costs and severity associated with teleradiology claims were well above radiology claims with no telehealth component.
Some top-line conclusions are that outpatient harm was relatively common and often serious, with a call to action for intervention in outpatient errors. Drs. David Levine and David Bates of Brigham and Women’s Hospital and Harvard Medical School are joined by their co-author and CRICO Chief Medical Officer, Dr. Luke Sato, who leads our discussion.
Several Harvard-affiliated medical institutions are piloting a program to provide personalized feedback to physicians about the effect of their behavior and interactions on others. More than 675 individuals have gone through the Rapid Pulse 360 evaluations as of Spring 2024. Can it have an impact on employment practices claims or provider-to-provider communication factors? And can follow-up one-to-one coaching help?
As artificial intelligence, or AI, takes off in the public sphere, what about medicine? The health care industry has been using some form of AI for decades, yet very recent advancements are upping the ante. This episode of Safety Net presents excerpts from a recent talk to malpractice attorneys by health care AI expert, Dr. Steven Horng, MD, MMSC, of Beth Israel Deaconess Medical Center and Harvard Medical School.
The Harvard teaching hospitals and their affiliated institutions have banded together to tackle one of the most difficult and deadly challenges that face all health care providers: clinical tests and specialty referrals that are lost to follow-up. Anecdotal evidence already shows patients who were rescued by the Ambulatory Safety Net project. Navigators are convincing patients to follow through, and results are being flagged.
In late 2023, the Academic Medical Center Patient Safety Organization issued an advisory noting a spike in reports of retained surgical items. A retained surgical item is patient safety lingo for when the surgical team leaves something like a sponge or a tool inside the patient after surgery. These events may lead to serious harm, such as sepsis, prolonged hospitalization, the need for subsequent surgery, or death.
The topline data from Candello claims analysis do not show an increase in malpractice corresponding to the increased use of APPs. In fact, the claims rate may be declining, adjusting for practice population increases.
A former doctor defendant found meaning after the ordeal despite her lack of preparation or role models. Dr. Gita Pensa, an emergency medicine physician, made it her professional focus to help other physicians through to the other side of the litigation journey.
The boarding of critical care patients in the emergency department is an increasing concern because ICUs are often also too full to take them.
Healthcare providers are facing new threats from online attacks that require new strategies to limit liability, harm to patients, and revenue loss. In spring of 2023, the Academic Medical Center Patient Safety Organization (AMC PSO), issued an updated Patient Safety Alert: Cyber Security and Recovery, available on the CRICO web site.
When it comes to medical notes in patient charts, copying and pasting carries risks of confusion, patient harm, and liability for providers.
Recent data from the National Academies of Science, Engineering, and Medicine show that sexual harassment and gender discrimination affect up to 50 percent of women medical students and more than 50 percent of women faculty in medicine. It affects men too.
It is estimated that thousands of medical specimens are lost each month. The impact on the diagnostic process when a specimen is lost is of particular concern. In early 2022, a patient safety document was published by the Academic Medical Center Patient Safety Organization, or AMC PSO, to describe ways to prevent harm to patients when specimens are lost. Safety Net interviews two participants with some advice for QI.
It is estimated that thousands of medical specimens are lost each month. The impact on the diagnostic process when a specimen is lost is of particular concern. In early 2022, a patient safety document was published by the Academic Medical Center Patient Safety Organization, or AMC PSO, to describe ways to prevent harm to patients when specimens are lost. Safety Net interviews two participants with some advice for QI.
Find out how to respond when patients decline recommendations around virtual care. The AMC PSO patient safety alert, called Informed Patient Refusal in Virtual Care, includes a review of likely malpractice allegations and contributing factors. Safety Net interviews one of the co-authors, Dr. Adrienne Allen, Senior Director of Quality, Safety and Sustainability at North Shore Physicians Group Mass General Brigham Salem.
Discrimination and harassment: what’s happening in the Harvard medical system, as a national movement and local lawsuits press institutions to change?
Harvard’s national database of coded medmal claims leads to changes across the country.
Related specialties have seen declines in their rate of malpractice suits, but hospitalists have seen their rate of claims remain steady or worsen slightly, while the severity of their cases has gone up.
CRICO assessments are conducted by the patient safety department within their own captive insurer, with no punitive component.
Massachusetts courts try a limited restart this year after trials were suspended, and all non-emergency court business was stopped cold by the pandemic.
Lowering the age for asymptomatic colon cancer screening from 50 to 45 suggests some important changes for physician practices.
CRICO funds work to make therapeutic hypothermia more reliable and maximize its effectiveness.
Until recently, inter-hospital transfer has been under-appreciated as a patient safety risk.
New federal law gives patients access to almost everything in their medical record, including clinical notes.
A new guide to help reduce risk when providing care in the virtual setting is now free online.
For vulnerable and under-served communities, patient safety and quality care were at added risk from the COVID-19 pandemic. At Massachusetts General Hospital in Boston, an established team for care equity and diversity knew early on in the pandemic that they had a lot of work to do.
An organized, full embrace of openness is taking hold with a growing number of medical malpractice insurance programs.
Excellent palliative care is inherently challenging; pandemic conditions make it harder
Many health care practices are under financial duress from the COVID pandemic, and this is affecting access to care and causing concern over patient safety.
Researchers find three factors that can predict whether a medical professional liability case will end in a payment.
During the COVID-19 pandemic the courts are prioritizing criminal cases, forcing medical malpractice trials and clinician defendants to wait.
Telehealth, or virtual health care: two national experts explain the patient safety and risk management issues related to virtual visits, and how has the pandemic affects all of this.
A special report: learn about the law changes protecting MA providers during the crisis.
A special report: Harvard's medical malpractice liability program, CRICO, is giving providers extra coverage without extra premiums during the crisis.
A patient safety leader retires, looks back, and prescribes a data-heavy future to manage risk and promote safety.
It's easy to see how patients become confused and dissatisfied in a busy healthcare environment. Multiple risks to patient safety may lie in this scenario; trust, adherence, follow-through, and patient engagement are all on the line. One researcher at Harvard thinks a lot of this can be cleaned up and made safer with a simple card that a physician hands to a patient when they first meet.
Can electronic health records be re-designed to reduce the scourge of clinician burnout?
Breast cancer is the leading cause of non-cutaneous cancer death among women between the age of 45–60.
With an aging population, concern turns to aging surgeons. Experience versus cognitive decline.
About 2 in every 1,000 patient orders in the fast-paced, high-pressure ER environment involve the wrong patient. Can photo IDs help?
Dr. Einstein is an attending oncologist in the genitourinary program at Beth Israel Deaconess Medical Center in Boston, and an instructor of medicine at Harvard Medical School.
Specialists in the Harvard system updated the CRICO Breast Care Management Algorithm in early 2019
Harvard researcher offers variety of methods to anticipate mistakes with diagnosis and prevent them.
Internationally renowned prostate expert Marc Garnick, MD, with clinical insights behind a leading cause of malpractice claims.
Against the downward trend: Malpractice cases in the U.S. that involve cardiology appear to be on the rise and getting more expensive.
We have learned a lot about risks in inpatient care, but there is still lots to learn about safety outside the hospital.
How getting involved in measuring error, analyzing the data, and helping develop interventions to prevent patient harm, transformed this physician.
Generational expert says clinicians can deliver better care by knowing something about each of the current seven generations they live and work among.
part III: A new evidence-based tool helps doctors and practices close the loop on referral failures that may harm patients and lead to lawsuits
part II: A new evidence-based tool helps doctors and practices close the loop on referral failures that may harm patients and lead to lawsuits
Patients' family members are providing direct care between doctor and hospital visits, so what's their role in patient safety?
A new evidence-based tool helps doctors and practices close the loop on referral failures that may harm patients and lead to lawsuits
Providers at the IHI quality conference heard the message: doctors and nurses deserve to have joy in their work. More than that, the happiness of clinicians is essential to good patient care.
Multi-institution collaborative meets to improve care and promote safety in the ambulatory setting.
An advancement in the care of newborns so profound it has patient safety leaders at Harvard pushing hard to spread its use in every-day practice.
CRICO's grant-funded research advances patient safety across disciplines and care settings.
Nearly 3 in 10 medical malpractice cases have identifiable problems with communication, according to a report by CRICO, the malpractice insurer for the Harvard medical institutions. Proven solutions highlighted a national gathering of patient safety leaders in Boston.
patient safety leader David Bates shared a vision of the next five years of health information and electronic medical records.
Program tests whether giving patients access to doctor's notes can improve safety and adherence to plans.
Preparation for the deposition and trial testimony can be paramount to a successful defense.
The clear conclusion of CRICO's new analysis of national malpractice data is that diagnostic errors should be among the highest priorities for intervention.
The clear conclusion of CRICO's new analysis of national malpractice data is that diagnostic errors should be among the highest priorities for intervention.
Social media mis-use by physicians is a new area for intervention by professional health services.
How to change cultures at your hospital/office practice/clinic for the sake of patient safety and satisfied clinicians
How do PCPs maintain strong bonds with their patients as care shifts to a team-based model?
Harvard's fight against medical error includes millions of dollars in 2014 for a dozen research and intervention projects.
If health care providers use a clinical guideline when they evaluate a patient--and the patient has a bad outcome, are the providers legally free and clear?
It's not quite the wild west, but the outpatient setting is a very different environment for patient safety than inpatient care. From across the Boston area, Harvard-affiliated physicians share the unique challenges and potential pathways to making care outside of the hospital safer for themselves and their patients.
Anesthesia safety pioneer Jeffrey Cooper speaks to Harvard's malpractice insurer about its own successes in patient safety over three decades, and how the link between CRICO and its hospital owners should be a model around the world.
Anesthesia safety pioneer Jeffrey Cooper speaks to Harvard's malpractice insurer about its own successes in patient safety over three decades, and how the link between CRICO and its hospital owners should be a model around the world.
What can help reduce work-related stress and the danger it poses to providers and their patients?
Doctors are less accurate with difficult diagnoses, yet research shows that their level of confidence in in their conclusions remains high in those cases.
Doctors are less accurate with difficult diagnoses, yet research shows that their level of confidence in in their conclusions remains high in those cases.
Electronic medical records are supposed to make care more efficient and less prone to mistakes that hurt patients. But physicians complain that EMRs are poorly organized and overly burdensome for caregivers. Is there a better system out there or is it time to dream big?
Whether it was from humble beginnings or high expectations or both, six Harvard physicians share how they decided to enter the healing profession. Their individual journeys are as unique as they are, and the path was not always straight.
Missing chemotherapy orders drop from 30 percent when patients arrive for treatment, down to two percent. This means patients aren't delayed and doctors aren't scrambling.
Disclosure and apology after an adverse event is encouraged a lot, protected a little, and admissible if the clinician does a bad job of it.
Doctors in training often mistakenly assume they cannot be sued if they followed their superior's care plan, but a Boston defense attorney sets them straight.
An online Medscape poll reveals which specialty has the most and least happy members, and CRICO interviews physicians to find out how they reduce stress and stay motivated.
(Part 2 of 2) The "Father of Patient Safety" reflects on the impact of the patient safety movement a decade after the IOM report….its successes…and its disappointments, from a national vantage point.
(Part 1 of 2) The "Father of Patient Safety" reflects on the impact of the patient safety movement 10 years after the IOM report.... its successes…and its disappointments, from a national vantage point.
A consent discussion with patients leads the PSA testing advice in a Harvard-generated tool to help primary care MDs manage prostate care.
Strong indicators that telling nurses when to call the doctor to the bedside reduce bad outcomes.
Physicians who express empathy get higher ratings by their patients on other care issues.
A physician and a lawyer discuss hazards of increasing the use of telephone advice from specialists.
Even if negligence didn't cause a patient's death, it may be compensable if it lessened the chance of survival.
As more and more health care is provided in the ambulatory setting, the data from malpractice carriers show that more and more lawsuits get their start in the same setting.
How are physician responsible when patients don't keep appointments or test results don't come back? Guest commentator John Cassidy, JD of Ficksman and Conley, Boston, MA.
Research helps surgeons find ways to communicate better to prevent mistakes before, during, and after surgery.
Fetal monitor strips, family history forms, and other non-medical record documents need to be preserved.
Joint Commission pushes new standards for reconciling lists and dosage of medications as patients change settings.
During the CRICO Surgical Summit in Boston, presenters and attendees explored the complexity of disclosure and apology. Panelist Philip Murray shared his perspective from 30 years as an active trial lawyer, and explained his support for open disclosure of adverse events—with some caveats.
A Q and A with Jack Mc Carthy, president of Harvard's self-insurance medical malpractice company about guidelines, simulators, and the future of patient safety.
New research underscores the need, effectiveness of formalizing sign-out and discharge summary processes.
Boston attorney Ted Mahoney tells obstetricians that a few notes about evaluating the pelvis before and during labor, and describing shoulder dystocia maneuvers will improve their chances if a lawsuit results from Erb's Palsy.
Part 3 of an address by best-selling author and Harvard Professor of Medicine Jerome Groopman to a patient safety symposium in Cambridge about the cognitive processes that lead physicians to make an incorrect diagnosis. Part 1 reviewed the ways physicians seek and process information on their way to making correct and incorrect diagnoses. Part 2 involved how how thinking errors occur. Part 3 looks at how to apply this knowledge to improving diagnoses in medical practice.
Best-selling author and Harvard Professor of Medicine Jerome Groopman speaks to a patient safety symposium in Cambridge about the cognitive processes that lead physicians to make an incorrect diagnosis. Part 1 reviewed the ways physicians seek and process information on their way to making correct and incorrect diagnoses. Part 3 will look at how to apply this knowledge to improving diagnoses in medical practice.
Best-selling author and Harvard Professor of Medicine Jerome Groopman speaks to a patient safety symposium in Cambridge about the ways physicians seek and process information on their way to making correct and incorrect diagnoses. Subsequent segments Part II and Part III will review how thinking errors occur, and how to apply this knowledge to improving diagnoses in medical practice.
When they became patients, these five physicians found that communication, attention to detail, and willingness to learn from error were all missing sometimes.
The idea is how do you take that big wedge of paper and divide it to the appropriate provider and then how do you stratify what is urgent and what is not urgent?
A technique for using senior hospital executives to improve patient safety is proving so successful that one hospital in Boston is now applying it to ambulatory sites.
When a patient has an adverse medical event, it may or may not be the result of a medical error. Legal Editor Frank Reardon says that what you do after an adverse outcome has a lot to do with whether a patient wants to sue someone.
Research indicates primary care physicians often lack vital clinical information about patients during office visits. In a study conducted by University of Colorado researchers, physicians reported that one in seven appointments lacked significant clinical information about the patient, such as lab results, medications, and history.
In their discussion of imperfection, Malcolm Gladwell and Dr. Atul Gawande will break down the thinking process, and examine how the various components impact health care providers. Gladwell and Gawande explore how "thinking without thinking" can hurt clinicians -- and patients -- and how it can help them.
Dr. Thomas Delbanco of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston has blazed a trail in primary care and patient-centered care for more than three decades. In his film he aims to give viewers some sense of how we might sort out the experience of patients who've had things go wrong for them.