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UK Executive Summary: MORPH UK Project Survey, February-May 2003 THE PROJECT Management of Risks and Practices in Healthcare (MORPH) is a trans-national study examining risks in healthcare institutions, focusing on the implementation of best practice training. The Project is co-funded by the European Commission under the Leonardo da Vinci Programme and involves Partners in four countries, Bulgaria, Ireland, Poland and the United Kingdom. The Project coordinator and project originator is the Interesource Group (Ireland) Ltd. Partners involved include the Health Care Association, Burgas, Bulgaria; the Division of Legal Medicine, University College, Dublin, Ireland; the Foundation for Promotion of Entrepreneurship, Lodz, Poland and the Dept. of Medical Physics, University of Dundee, UK. MORPH aims to identify trends and practices in healthcare institutions and increase awareness of risk management across Europe. In order to equip practitioners and professionals involved in healthcare with the necessary risk management skills, the project will produce: THE SURVEY A comprehensive survey was designed and distributed in each of the four countries identified above. Over 850 completed responses were recorded. The survey was carried out between early February and early May 2003 and was targeted at healthcare practitioners in both the primary and secondary sectors. In the UK, 1,650 copies of the questionnaire were dispatched to database addresses of healthcare practitioners and through mailings to members, organised by institutions in the healthcare field. 206 questionnaires were returned completed, of which 21 were filled in on line. 88% of the responses came from NHS Acute, Primary Care and Ambulance Trusts, with 10% originating in General Practice. 49 % of respondents described themselves as risk managers, health & safety managers, risk coordinators or corporate governance managers. Other significant groups represented included senior administrators, executive directors and medical directors, 26 %, consultants 13%, & general practitioners, 9 %. The other 3% were made up of chief executives, academics and nurses. SUMMARY OF KEY FINDINGS THE RISK MANAGEMENT PROCESS The survey sought to identify elements of the risk management process within organisations. Of the respondents: These findings demonstrate that the vast majority of organisations in the UK have a risk management process in place, with the majority satisfied with the process and the ability of it to improve quality of patient care. RISK MANAGEMENT EDUCATION AND TRAINING MEDICO-LEGAL ASPECTS OF CLINICAL AND NON-CLINICAL RISKS BENEFITS, OUTCOMES AND IMPACT Since the introduction of the risk management process: However in some of these cases, 40-55% of all respondents were not able to answer definitively with a figure for change, either increase or decrease. This suggests that more careful monitoring of the outcomes of the process is necessary in many cases. All the findings in this section suggest that the benefits of the risk management processes that are in place in the UK have yet to achieve their full potential for positive change. ROLE OF THE COURTS AND GOVERNMENT CONCERNS FOR THE FUTURE: This Survey reveals a fairly advanced and sophisticated system of risk management process is in place in the UK but the benefits are still to be fully revealed and there are legitimate concerns for the future. FOR FURTHER INFORMATION ON THE UK SURVEY, please contact: Dr Ian Chapman tel: + 44 (1382) 632604 Ninewells Hospital & Medical School fax: + 44 (1382) 640177 Dundee DD1 9SY e-mail : ian.v.chapman@tuht.scot.nhs.uk website : http://www.dundee.ac.uk/medphys/sections/morph |
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Executive Summary - IRELAND ABOUT THE PROJECT MORPH, a transnational study, examines risks in healthcare institutions, focusing on the implementation of best practice training. Interesource Group (Ireland) Limited, project originator and coordinator has established a Europe-wide consortium consisting of the Division of Legal Medicine, University College Dublin, Ireland; the Department of Medical Physics, University of Dundee, Scotland; Foundation for Promotion of Entrepreneurship (FRP), Poland and the Health Care Association, Bulgaria. MORPH aims to identify trends and practices in healthcare institutions and increase awareness of basic risk management across Europe. In order to equip practitioners and professionals involved in healthcare with the necessary basic risk management skills, the outcomes of the project will be: THE SURVEY A survey was distributed in each of the four partner countries and over 850 responses in total were recorded. The survey was targeted at healthcare professionals and management in both the primary and secondary sectors. In Ireland, the respondents consisted of risk managers, health boards and/or hospitals, general practitioners and dentists. INSTITUTION % General Practice 38 Dental Practice 25 Public Hospitals 22 Health Boards 10 Hospices 3 Other 2 RESPONDENTS TO THE SURVEY SUMMARY OF KEY FINDINGS THE RISK MANAGEMENT PROCESS The survey sought to identify elements of the risk management process within organisations. Of the respondents: These findings demonstrate that whilst the quality of patient care is of great importance to organisations the majority of organisations do not have a defined risk management process in place. There is a high level of dissatisfaction with the risk management process amongst Irish healthcare professionals. RISK MANAGEMENT EDUCATION AND TRAINING MEDICO-LEGAL ASPECTS OF CLINICAL AND NON-CLINICAL RISKS Topics in which training is mostly provided by organisations are: Training in medical ethics, inter-professional communication and clinical negligence law is also provided by some organisations. Established protocols exist in organisations in relation to a number of health and safety matters including: 25% of the organisations which responded experienced an increase in clinical negligence litigation in the last 3 years, while only 2% experienced a decrease. 73% of respondents reported no change. BENEFITS, OUTCOMES AND IMPACT Since the introduction of a risk management process; 37% of respondents reported a definite and measured improvement in the quality of patient care; staff morale has increased in 42% of cases; a reduction in litigation was observed by 4% of respondents and 16% experienced a reduction in patient complaints. 69% of organisations reported no reduction in medical indemnity costs nor was there a reduction in public liability insurance costs in 70% of cases. 25% of organisations stated that the improvement of the risk management process would directly reduce costs relating to litigation. 69% of respondents said that any reduction in litigation costs would further enable their organization to improve the delivery of healthcare. An investigation into the impact that risk management has had on patient care found that there was a considerable impact in 10% of the cases and some impact in a further 43% of cases. No impact was perceived by 16% of the respondents. ROLE OF THE COURTS, ADR AND GOVERNMENT 62% believe that the provision of a medium for a fair hearing is the most important role a court of law should play in clinical negligence cases. 30% think that setting standards of care in the healthcare profession is more important. Compensation of injured patients is also considered by some respondents as the most important role of a court of law. Opinion is split as to whether clinical negligence/litigation should be removed from the court system (44%) or maintained and improved (55%). A dual system of arbitration and courts was also suggested (1%). The improvement of clinical negligence/litigation can be best achieved through the introduction of specialised medical courts according to 78% of respondents. 88% of respondents felt that alternative dispute resolution (ADR) could be utilized in relation to matters of clinical negligence. A patient complaints system provided by the healthcare provider was ranked as most important. 58% of the respondents felt that the Government should have a role in the regulation of the risk management process in Ireland. This survey indicates that where a risk management process is in place the quality of patient care is improved. However, there is no reduction of indemnity/insurance costs. Healthcare professionals clearly see a place for mechanisms of Alternative Dispute Resolution (ADR). However, the largest number of respondents preferred to see clinical negligence litigation remain within the court system but be improved. They thought that this improvement was best achieved by the introduction of specialised medical courts. |
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POLAND - Executive Summary Poland's comprehensive health care reforms have uncovered and highlighted a number of problems and challenges. To address these issues requires not only an entirely new legal and organizational approach but also the development of effective instruments to moderate the increasingly problematic nature of various risks accompanying, and intensified by, these reforms. Those risks directly related to the work of doctors and healthcare centres are the main areas of concern. Such risks, the most pertinent of which at present is civil liability, are becoming extremely expensive and present dangers to providers of medical services and their patients, ie Polish society at large. For further analysis of this data, a questionnaire in Polish, which directly reflects the format used in all countries participating in the Morph Project, was used. The survey was conducted between February and July 2003. The questionnaire was mailed to 2001 randomly selected organizations comprising of 523 public and private hospitals, 808 medical centres and 670 dental clinics. It was also available on the website of the Foundation for Promotion of Entrepreneurship, which included a glossary of terms used in the questionnaire for those interested. The survey 204 completed questionnaires were received. The breakdown of Polish respondents was as follows: 61% of respondents were the individuals in their organisation with sole responsibility for the Risk Management procedures. Of the remaining respondents, 35% shared the responsibility with one or two other people while the remaining 4% shared responsibility with between three and five people. The findings show that risk management is predominantly a part of a manager's responsibility rather than a team task. Risk Management Policy Almost 40% of participants stated that their organisation has a specific risk management procedure in place, identified by set objectives and taking the form of a written mission statement, part of an induction pack, or similarly communicated to staff. Although this percentage is quite low, it was reported by many of the remaining 60% that although there was an absence of set requirements regarding risk management in their institution and the policy was not formalised, risk management is in fact practiced. Risk Management & Education 30% of the organisations surveyed confirmed the presence of a system of continuing education for those responsible for risk management within their organisation. 46% of respondents reported a system of continuing education in place for clinical personnel. Role of the Courts, ADR and Government The majority of respondents are of the opinion that the government should have a role in the regulation of the risk management process in Poland with over 50% of respondents in favour. According to 90.3% of respondents medical negligence should remain within the framework of competence of general courts. However, the system should be more efficient. Quite a number of participants in the survey suggested the use of specialised medical tribunals to deal exclusively with medical negligence cases. Accelerated procedures in general courts as a way of improving the situation in the area of medical negligence cases was suggested by a much smaller group. Conclusions |
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Executive Summary Bulgaria ABOUT THE PROJECT MORPH, a transnational study, examines risks in healthcare institutions, focusing on the implementation of best practice training. Interesource Group (Ireland) Limited, project originator and coordinator has established a Europe-wide consortium consisting of the Division of Legal Medicine, University College Dublin, Ireland; the Department of Medical Physics, University of Dundee, Scotland; Foundation for Promotion of Entrepreneurship (FRP), Poland and the Health Care Association, Bulgaria. MORPH aims to identify trends and practices in healthcare institutions and increase awareness of basic risk management across Europe. In order to equip practitioners and professionals involved in healthcare with the necessary basic risk management skills, the outcomes of the project will be: THE SURVEY A survey was distributed in each of the four partner countries and over 850 responses in total were recorded. The survey was targeted at healthcare professionals and management in both the primary and secondary sectors. In Bulgaria the respondents consisted of risk managers, health boards and/or hospitals, general practitioners and dentists. The survey reports on the current situation in Bulgaria 3 years after the start of the healthcare reform and contains information about four of the most important institutions in the management of healthcare in the country (the Ministry of Health, the National Health Insurance Fund, the Bulgarian Medical Doctor's Union and the Union of the Dentists in Bulgaria) and their basic functions, obligations and activities. 206 completed questionnaires were returned. SUMMARY OF KEY FINDINGS - THE RISK MANAGEMENT PROCESS The survey sought to identify elements of the risk management process within organisations. Of the respondents: RISK MANAGEMENT EDUCATION AND TRAINING MEDICO-LEGAL ASPECTS OF CLINICAL AND NON-CLINICAL RISKS The top five topics in which training is mostly provided by organisations are: Training in medical ethics, inter-professional communication and clinical negligence law is also provided by some organisations. Established protocols exist in organisations in relation to a number of health and safety matters including: 25% of the organisations which responded experienced an increase in clinical risk management. BENEFITS, OUTCOMES AND IMPACT Since the introduction of a risk management process; 39% of respondents reported a definite and measured improvement in the quality of patient care; staff morale has increased in 51% of cases; a reduction in litigation was observed by 27% of respondents and 36% experienced a reduction in patient complaints. 28% of organisations reported no reduction in medical indemnity costs nor was there a reduction in public liability insurance costs in 28% of cases. 63% of organisations stated that the improvement of the risk management process would directly reduce costs relating to litigation. ROLE OF THE COURTS, ADR AND GOVERNMENT 42% of respondents believe that the provision of a medium for a fair hearing is the most important role a court of law should play in clinical negligence cases. 37% think that setting standards of care in the healthcare profession is more important. Compensation of injured patients is also considered by some respondents as the most important role of a court of law. 75% of respondents think that clinical/medical negligence should be maintained within the courts. However, 54% of these respondents think that special medical courts should be created. 60% of respondents felt that alternative dispute resolution (ADR) could be utilised in relation to matters of clinical negligence. A patient complaints system provided by the healthcare provider was ranked as most important. 52% of the respondents felt that the Government should have a role in the regulation of the risk management process in Bulgaria. CONCLUSIONS |
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