Improving Quality and Achieving Equity:
A Guide for Hospital Leaders

 Identifying areas that expose the hospital or its health care providers to liability is critical in managing risk. When such situations are identified, there is an opportunity to engage in a set of activities that can prevent tort and untoward settlements—which can be both costly as well as detrimental from a public relations standpoint. There are multiple liability exposures that arise when providing care to diverse patient populations. They include situations that relate to: (94)

• Patient comprehension of their medical condition, treatment plan, discharge instructions, complications and follow-up.
• Inaccurate and incomplete medical history.
• Ineffective or improper use of medications or serious medication errors.
• Improper preparation for tests and procedures.
• Poor or inadequate informed consent.
• Use of interpreters who are not properly trained, cannot accurately translate medical terms and conditions or are not adequately conversant in the patient’s and physician’s languages.

Many of these areas also constitute patient safety issues, and therefore take on added importance. For example, a patient’s ability to read, understand and act on health information has a direct impact on the physician-patient interaction and patient safety. As it relates to prescriptions, a patient’s ability to know if they have received the correct medication, or their ability to follow instructions regarding their medication (including dose, frequency and time), both constitute safety and risk management scenarios. Written communications, in the form of appointment slips (appropriate time, date, location), referral slips (reason for referral, name and location of provider, instructions regarding preparation), intake and discharge instructions, and most commonly, informed consent, are all fair game for liability.

Risk management experts have recently reviewed case law and settlements with an eye towards issues related to patients’ race, ethnicity, culture, and language proficiency (94).  Communication issues represent a key component of claims filed by patients whose culture, ethnicity, religion and/or English language ability differ from that of the physician or other healthcare provider. Hallmarks of poor communication leading to tort have included:

• insufficient explanations
• discounting pain and suffering
• failure to recognize or take into account the patient’s cultural, religious, or ethnic beliefs
• the use of language suggesting abandonment

Settlements related to communication problems between the patient/family and provider have centered on lack of, or inadequate informed consent for surgical or invasive procedures as well as inadequate identification of provider and/or provider’s professional designation; inadequate understanding of explanation, educational material, follow-up instructions and/or discharge instructions; inadequate information provided regarding adverse events and proposed corrective action; poor or negative rapport; and poor telephone communication.

In sum, identifying root causes for disparities that are centered on race, ethnicity, culture, or language proficiency may provide an opportunity to manage risk. As our patient population becomes increasingly diverse, settlements in the area of disparities will no doubt continue to emerge. Developing mechanisms to identify and address disparities will improve patient safety and minimize risk.

The Quality Case
The Business Case
The Accreditation Case

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