From the Director

The seven demonstration projects that are part of AHRQ's Medical Liability Reform and Patient Safety Initiative have the potential to transform how our nation's health care system handles medical liability. These projects are building evidence that alternative approaches to traditional medical liability, linked with different responses when patient harms do occur, can improve patient safety, reduce malpractice suits and premiums, reduce the costs of defensive medicine, and fairly compensate patients and families who have been harmed my medical errors.

Rather than the old approach of "deny and defend," these projects focus on finding ways to reduce harm before it leads to a lawsuit, increase transparency, learn from patient safety events to prevent future errors, and fairly and quickly compensate patients who have been harmed by errors. Like all the projects, the ones discussed in this month's cover story have made great strides. The Seven Pillars Program first and foremost seeks to prevent patient harm by reporting—and correcting—flaws in processes that can undercut the work of the most dedicated clinicians. Second, the environment fostered by communication and disclosure builds respect and trust, which figure prominently in the well-being of patients and physicians. Third, the Seven Pillars process establishes and reinforces a culture of learning, especially among medical residents who have previously had few opportunities to identify and learn from patient safety events.

The result at the University of Illinois is a 40 to 50 percent reduction in claims and lawsuits per quarter compared to 6 or 7 years ago, a 22 percent reduction in the hospital system's medical malpractice premium for FY 2013, and $3 million in annual savings to payers, including Medicare and Medicaid. The Fairview Health Services project to reduce preventable birthrelated injuries and related malpractice claims demonstrates the value of best practices such as checklists, communications techniques, teamwork, and simulation exercises for reducing medical errors. The result has been a 74 percent reduction in preventable birth trauma to fullterm newborns, a 38 percent reduction in preventable neonatal intensive care unit admissions of full-term babies, and a 12 percent reduction in the rate of birth-related maternal complications at term.

Finally, the judge-directed negotiation program of the New York State Unified Court System has begun to shift the dynamic of civil medical malpractice actions from an attorney-driven process to a judge-managed process. The 200 cases that have gone through the program have shown substantial savings in time and money from traditional litigation. I am very heartened by the progress made by all the demonstration projects. I am also encouraged by the many hospitals that are interested in replicating these innovative programs.

Carolyn M. Clancy, M.D.

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