#MEQAPI – Tweetchat March 23rd 2017 3ET: Quality Improvement vs Proneness for Malpractice Claims

Next tweetchat: Thursday March 23rd, 2017 3:00-4:00 PM ET

Topic:  Quality Improvement vs Malpractice Claims

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

Malpractice claims are a disruptive nightmare for providers, and the chances are that every provider will experience this firsthand at some point in their career. However, the probability of a malpractice claim is not evenly distributed, and some providers are far more likely to have claims made against them for malpractice than others. Proneness to malpractice claims can be reduced, and we can take proactive steps through quality improvement to greatly reduce the likelihood of the nightmare of a claim.

This week the #MEQAPI topics are based on the Physicians’s Weekly article “Examining Proneness to Malpractice Claims” that reviews malpractice claims variation between physicians and specialties. We will look at proneness to malpractice claims for each of the typical arms of the basic Quality Improvement Ishikawa diagram that may look something like:


Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

  • Methods
    • Policies: either unit, office, organization, or national policies that might increase malpractice risks.
    • Workflow: how things are done that might increase risks of errors, or antagonize the patient, or create gaps in handoff, etc.
    • Standard work: Standard operating procedures that may increase risk
  • Machines
    • Medical or office equipment that might increase risk of malpractice claims, old, broken, poorly installed, etc.
    • Software systems (especially EHR?), that might lead to HIPAA issues, frustrate patients, cause medical errors like wrong pt, wrong site, wrong meds, failure to follow up, etc.
  • People
    • Staffing: insufficient or unqualified staff
    • Training: insufficient base training, incorrect training, insufficient CME, etc.
    • Attitudes: staff attitudes e.g. paternalism, rudeness, etc.
  • Materials
    • Forms: duplicative or incomplete forms
    • Supplies: medical or office, inferior fax paper, lack of coffee(!)
    • data? – sent to wrong recipient, not shared with pt or specialist, etc.
  • Measurement
    • KPIs: operational metrics that focus on the wrong things, or are poor measures, and that drive wrong behavior
    • Targets: improper or unachievable performance targets
    • Incentives: improper, biased, or discriminatory rewards
  • Environment
    • Noise: distracting noises, sound levels too high, etc.
    • Space: cramped, uncomfortable, slippery surfaces, etc.
    • Lighting: too dim, glare, poor contrast, etc.
    • Location: things not where they should be, too much movement of staff, pt, or equipment needed, etc.

The aim of this chat is look at each of these dimensions of cause, and discuss what we have seen before for that dimension that has been a risk or developed into a malpractice claim, or that we anticipate is likely to become an issue or end up as a malpractice claim.


  1. What Methods (policies, workflow, etc) have you seen or anticipate may increase risk or have led to malpractice claims
  2. What Machines (med/office equipment, EHR/SW) have you seen or anticipate may increase risk or have led to malpractice claims
  3. What People issues (staffing, training, attitudes) have you seen or anticipate may increase risk or have led to malpractice claims
  4. What Materials (forms, supplies, data?) have you seen or anticipate may increase risk or have led to malpractice claims
  5. What Measurements (KPIs, targets, incentives) have you seen or anticipate may increase risk or have led to malpractice claims
  6. What Environment issues (noise, space, lighting) have you seen or anticipate may increase risk or have led to malpractice claims


The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered.


The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

meqapi March 23


Published by

Matthew Loxton

Healthcare Analyst using Lean Six Sigma, Knowledge Management, & Organizational Learning to improve healthcare http://linkedin.com/in/mloxton

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