Clinical negligence: Doctors and managers must learn from litigation claims, say experts

Dear Editor,

Many authors have long debated whether in-depth analysis of incident reporting can help promote the quality of assistance, because those who deal with reporting and root cause analysis feel there are not enough resources to solve problems and that there is no known solution (1).

This principle can also be transferred to the analysis of claims and constitutes a limit to the aspiration of the authors of the Getting It Right the First Time (GIRFT) programme (2), which is about the contents of the analyses performed on claims being translated into instructions, recommendations or anything else useful to meeting the objective of safety.

Nevertheless, the path outlined in the GIRFT programme should be followed not only with the aim of containing health expenditure for compensation, but also because it is quite clear that incident reporting and claims are not disconnected at all, but rather represent two faces of the same coin.

For this reason, it may be useful to extend the application of predictive tools widely used in the insurance world to the evaluation of incident reporting. This refers, for example, to the actuarial tools used to establish claims reserves and is based on the Incurred But Not Reported events (IBNR) concept that could be transferred to incident reporting, achieving a credible projection of the expected reports based on the historical series of reports registered by accident type in a health facility.

In this way, building on predictive trends, it will be possible to establish a comparison in the final balance, with consolidated data at the end of each year, and to evaluate possible deviation to guide strategies of possible improvements.

References

1. Peerally MF, Carr S, Waring J, Dixon-Woods M. The problem with root cause analysis. BMJ Qual Saf. 2017 May;26(5):417-42;
2. Rimmer A. Clinical negligence: doctors and managers must learn from litigation claims, say experts. BMJ 2021;373:n1165.