LAUSR

BACKGROUND The University of Pennsylvania Health System (UPHS) implemented a risk reduction strategy in response to high malpractice costs and the broader implications these trends had for patient safety and quality. A key component of this strategy was the Risk Reduction Initiative (RRI), which uses a bottom-up approach to actively engage physicians in risk mitigation and malpractice reduction within their respective departments. METHODS The value of clinical communities in achieving common goals has been previously recognized in quality improvement efforts. Using a physician-directed approach, the RRI program requires each clinical department to propose and execute an intervention in response to prior malpractice claims data or recognition of an area of high risk. Based on the success of the intervention, clinical departments were eligible to receive a financial rebate for use in future quality improvement projects. RESULTS Clinical departments have led the development and implementation of interventions that have shown demonstrable improvements in quality and safety and thereby received full financial rebates. On a system level, the inclusion of physicians in risk mitigation efforts has resulted in significant benefits from both quality improvement and financial standpoints. The number of malpractice claims and malpractice cost have decreased since the inception of the program. CONCLUSION Since the program inception, 250 proposals have been submitted and $14 million in rebates have been awarded. Although it is difficult to directly measure the combined impact of these bottom-up, physician-directed interventions, empowering frontline physicians to become actively involved in risk mitigation is a promising method for reducing malpractice claims and costs.