A large academic medical center asked TRA to evaluate the costs and benefits of introducing a Safe Patient Handling (SPH) program. The VDERM process allowed TRA to quantify all decisions for implementing the program, including determining its design, justifying costs, and balancing investments in other programs. Traditional valuation methods only cover cost and benefits that have been verified by extensive studies, but by using probabilistic models that give evidence-based insight where uncertainty exists, VDERM adds significant value to the clients’ risk management programs. “We were able to identify that for our client’s SPH program, change in employee turnover is the single biggest driver of uncertainty in program value. For example, suppose that investing $100,000 in communicating the benefits of the SPH program to employees could drive reduction in turnover from a base estimate of 2 percent to a 10 percent reduction. From one of the analytic outputs generated using VDERM, we were able to see that would increase total program value by around $1 million—a 10-to-1 return,” explains Driver.

Advanced Risk Management Strategies: From Patient Care to Making Patients Whole

The team at TRA believes that while it’s essential for healthcare providers to focus on both the upside and downside of risk, it’s also an imperative to provide the best possible patient care and when that care does not meet expectations, to compensate patients and otherwise make them whole. TRA’s aim is to help patients understand their treatment and care by addressing complex medical concerns in a comprehensive, compassionate, and confidential way. “Based on open communication, accountability transparency, and integrity, PEARL (Process for Early Assessment and Resolution of Loss) is our communication and resolution program,” remarks Driver. Rather than waiting for a claim or a lawsuit, TRA proposes engaging patients and families to find an early resolution. PEARL addresses the emotional impact of unanticipated events while reducing overall expenses. PEARL also acts as an alternative approach to medical liability processes while providing insights that trigger corrective actions, safety improvements, and ultimately high quality patient care.

TRA was engaged to solve a complicated case for a client’s hospital, and leveraged PEARL to arrive at a compromising solution. It was a case of medical negligence due to miscommunication between the emergency team, gastroenterology and radiology departments. A pediatric gastroenterologist wrongly inserted a percutaneous gastric tube in a five-month old boy with poor nutritional status and failure to thrive. A reading of the radiological imaging interpreted that the new G tube placement was in the stomach, while in fact the tube was in the colon. It took several hospital visits before the mistake was remedied, resulting in surgical intervention and a longer recovery time.

On behalf of their client, TRA was notified of the misinterpreted radiological read upon its discovery. PEARL was initiated, and as per PEARL protocol, in less than seven days, an internal radiological opinion concluded that the standard of care was not met. A physician member of hospital leadership, along with the PEARL Patient Liaison, met with the family to provide full disclosure and apology, a careful and clear explanation of the complex clinical picture, as well as lessons learned and quality improvement initiatives.

Following that meeting, TRA’s Claims team specialist took over resolution discussions with the family and resolved the claim, informed by TRA’s Decision Analysis Reserve Targeting process (DART). Rather than using guesswork and estimation to establish patient compensation, DART brings consistency and certainty to this ambiguous process by applying decision science and risk management tools to evaluate the uncertainties involved in litigation strategy.