Let us learn from litigation claims: actuarial tools can improve safety

Whether in-depth analysis of incident reporting can help promote the quality of assistance has long been debated because the people who deal with reporting and root cause analysis think that there are not enough resources to solve problems and that there is no known solution.1

This principle also applies 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 but rather 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” 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.

Building on predictive trends in this way will make it 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.