Health Courts and Root-Cause Analysis
Mello and Studdert describe the relationship of the health courts system to hospital-based improvement.
We have also thought about how a health court system could spur hospitals to conduct more root-cause analysis of their own adverse events. Although hospitals are in perhaps the best position of anyone to investigate what happened when an unexpected outcome occurs, this is not always done. We designed the health court model to put the initial onus on the involved hospital and its insurer to conduct an investigation.
When a patient files a claim, the hospital must conduct an investigation and determine whether it believes the injury was avoidable. If so, it must make an offer of compensation. This is not a neutral adjudication, but, as with settlement negotiations in the shadow of a lawsuit, the goal is to encourage early offers of compensation as well as reflection within the hospital about what happened and, if the event was avoidable, how similar injuries could be avoided in the future. (The health court, which would play the role of neutral adjudicator, would become involved in all claims that were not resolved to the satisfaction of both parties through this investigation-and-offer process). Health court oversight would ensure that appropriate investigations were conducted in every case and that offers were made in good faith.
In summary, a health court system could also provide new and important structural mechanisms for collecting, analyzing, and disseminating information about medical injuries and how to prevent them. Additionally, by jettisoning the negligence standard and its punitive connotations, a health court would contribute significantly to building a productive “culture of safety” within health care institutions. Our research strongly suggests that this is a proposal worth testing.