Born Inc. (BRRN)

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Quture Medical Malpractice Claims Model: (HFACS 9 install)

http://www.quture.com/quture-medical-malpractice-claims-model-hfacs-9-install/

Quture embeds HFACS in QualOptima as an integral classification and causation nanocodes system. QualOptima is available to healthcare providers to integrate quality management, risk management and credentialing on its unified database with analytics technology as Quture’s innovative and transformative Value Data Center. QualOptima is an extraordinary experiential learning platform, designed for organizational, clinician and patient learning to achieve optimal outcomes.

I do like the 5 phase model:

Phase 1: HFACS Training & Process Installation

Basic training in HFACS begins to introduce the system as a process with its methodology to learn fundamental concepts. The HFACS four (4) levels of failure and the causation nanocodes are taught by the Founders of HFACS, so the system and five (5) phased implementation are introduced. Examples of sentinel claims from the organization are used after standard training examples have been considered.

Initial training begins to focus on how events are identified and classified in HFACS. From this initial introduction to HFACS, begin with the end in mind will consider the ultimate collaborative processes of investigating and analysis of causation in a unified database. Root cause analysis (RCA) and failure mode and effects analysis (FMEA) are briefly considered in the context of HFACS analysis and the QualOptima system to continuously develop optimal clinical processes, including maximized patient safety.

Phase 2: Analysis Archived Claims Database

Despite the limitations discussed above using HFACS retrospectively in archived databases, there are two (2) primary benefits from examining medical malpractice claims databases. First, learning application of HFACS for claims managers and processors gives insight into the factors (expressed as nanocodes or exemplars) in each element of the four (4) levels of failure. Hands on learning provides high level understanding and insight into the gaps which may exist in investigated claims.

Second, the ultimate goal in Phase 5 is to evolve from single case review to use of the aggregated Qualytx unified database for medical malpractice in the QualOptima informatics platform. Phase 2 introduces aggregate data analysis for prevention strategies, using HFIX, to prevent medical errors or to intervene when they occur. This is ultimately the beginning basis of a unified, comprehensive, reliable database of medical error claims and liability exposures.

A study by Vicki-lynne Gloger is good example of learning from reported errors. Expert consultants will use HFACS to evaluate and develop this baseline database from insurance claims files. This phase is exponentially more valuable if individual insured risk management data is independently evaluated and developed for this baseline.

Phase 3: Install & Train QualOptima HFACS Informatics Platform

QualOptima with the HFACS application is installed with training in use of the software during Phase 3. Nanocodes are provided in a library for selection and potentially customization, and these advance considerations begin during Phase 2. The Qualytx aggregated database exists when installed, so that training includes analysis of aggregated data, as well as single case entry, investigation and analysis.

Causation analysis (including RCA), including HFIX, is also provided with introduction to software for use in both aggregate and single case use of QualOptima HFACS. Use of FMEA software for development of optimal clinical processes is available during Phase 3, as well.

Phase 4: Claims & Case Coordination/Collaboration

QualOptima is designed primarily as a connectivity and analytics platform for experiential learning. Coordination and collaboration between the insurer or self-insured trust, for opening and managing claims throughout the linear progression of each claim, is instructed and implemented in Phase 4 for participating providers.

Aggregate data analysis for prioritization of identified interventions is provided with the software functionality. Consultation and training on this functionality, along with single case data and investigation processes, are included during this phase. QualOptima as an experiential learning platform for pattern and trend analysis, focused on search and analytics, is trained and developed. Optimal clinical processes, including patient safety interventions, are the goal of this training phase for holding the gains in Phase 5.

Phase 5: Implementation

The progression through Phases 1 through 4 are designed to achieve the ultimate goals diagrammed for Phase 5 implementation.

QualOptima HFACS for Medical Malpractice Claims (B)
QualOptima HFACS for Medical Malpractice Claims (B)

The completed process results in the Human Factors framework for classification, then analysis, becoming the system empowered by technology by both, and between, medical malpractice insurers / self-insured trusts and health care providers as insureds. Coordination and collaboration begins at data entry for single case workflow, with both using the same HFACS processes. HFACS will become the investigation and analytics system, so causation is evaluated not only in a common fault and relative fault process, but pattern analysis from aggregated data can enable disciplined intervention and prevention strategies.

Costs of legal counsel and insurance administrative costs are discussed in the Section detailing the financial and economic consequences of medical malpractice insurance and litigation. The Quture HFACS coordination and collaboration between insurers and insureds will decrease the costs while making their processes more effective and efficient.

The ultimate goal of QualOptima HFACS is to reduce preventable medical errors, make patients more safe while simultaneously providing improved care and outcomes. The result will contemporaneously reduce the massive costs of these errors, and the loss of human life and suffering, both in the context of care and claims.

Defendants & Legal Theories:

Hospitals and physicians, as defendants in medical malpractice litigation, frequently have competing interests. The allegations and legal theories against them may include pleadings to even position one against the other. It is not uncommon for plaintiffs to sue hospitals, even though the facts and basis for the claim may be more obscure, because it is different suing a bricks and mortar, wealthy hospital with an executive at defense table than a physician taken from the patients who rely upon him or her. In most jurisdictions, the jury will not be allowed to know if there is insurance to pay a verdict; so a personal judgment is very different from the hospital corporation.

Quture believes that the new Joint Commission standards create new and serious liability exposures to hospitals for negligently credentialing doctors. This will be discussed separately; however, HFACS involves organizational and supervisory factors as two (2) of the four (4) levels of failure. Organizational influences include culture, processes and resource management. Inadequate supervision and planned inappropriate operations are key exposures for hospitals. Failure to correct known problems is a fundamental concern in hospitals, where financially lucrative routine practices, such as overuse and complication patterns may increasingly provide liability exposures. For physicians, the distinction between routine violations and exceptional violations (willful disregard to rules) is very significant in the context of unsafe acts. Whereas, administration knowledge of routine disregard of reasonably prudent practices is an example of lining up the holes in the Swiss cheese model.

Preconditions for unsafe acts impose another level of potential failures, where the hospital, responsible for nursing and other employee factors and physical factors, such as design of physical facilities (e.g., operating rooms) are within the prevue of the hospital rather than the physician. These are just 30,000 foot examples of negligence in the context of human error.


Very Nice imo.