Large Group Purchasers Have Power to Drive Improvements in Patient Safety

Study of institutional liability in large capitated physician organizations

From 1998 to 1999, researchers from the Institute for Health Policy Studies at the University of California, San Francisco, conducted an exploratory case study of innovative practices of large capitated physician organizations aimed at improving patient safety.

To gather data, the research team interviewed managers in 23 large capitated physician organizations with advanced patient-safety processes. (Capitation refers to an arrangement whereby care is guaranteed in return for a fixed, prepaid monthly fee.)

The project was part of the Robert Wood Johnson Foundation's (RWJF) Improving Malpractice Prevention and Compensation Systems national program.

Key Findings: The findings and conclusions reported by the investigators in the Journal of Health Politics, Policy and Law include:

  • "Demand for safety comes mostly from external factors—legal, market, and professional."
  • Indications are "that the biggest improvement in patient safety would come from boosting quality-safety demand from larger group purchasers, private and public."
  • "In the most advanced organizations, physicians have begun to see errors as ordinary shortcomings to be faced and managed rather than as unacceptable moral failings."
  • "Groups most commonly sought to reduce delay in diagnosis or misdiagnosis, which was perceived as the most common source of avoidable injury."
  • "In more advanced groups, risk managers received many oral and written reports on injuries or 'near misses' from multiple sources."
  • "Often, lawsuits helped focus organizational attention on processes that enabled an injury to occur."

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