[RISK MANAGEMENT IN COMMUNITY GYNECOLOGY: "CLAIM MANAGEMENT VERSUS RISK MANAGEMENT"].

INTRODUCTION: The goal of the study is to analyze the gynecological system in Maccabi HMO in the aspect of risk management and to define points for improving patient safety and minimalization of the risk of lawsuits. Maccabi's risk management system aims to improve the safety of treatment, which is based on independent gynecologists in private clinics (662 doctors), 20 women's health centers and 4 emergency centers in gynecology which provide solutions to urgent cases beyond working hours in community medicine. The service provides an answer to about 870,000 women with about 940,000 annual visits. Characteristics of events in gynecology at Maccabi: events related to pregnancy - 41%, to gynecologist 40%, laboratory 11% and doctor-patient interaction: 8% Event distribution by claim or claim potential: pregnancy 70%, gynecology 30%; in cases of pregnancy - 60% of claims are related to malformations. In the field of obstetrics: in 74% of cases there was a risk factor that could be detected during pregnancy. In pregnancy-related claims reveal that in most cases there are missing or structural defects or a genetic defect that was not diagnosed; in most cases of not finding a structural defect (64%) there was a maternal factor or other suspicious factor during pregnancy follow-up, that would contribute to an early diagnosis. In most cases of non-detection of a genetic defect (92%), some suspicious factor (maternal, familial or findings during pregnancy) could have been defined, which might have contributed to the diagnosis. In gynecological events occurring: about 17% were connected to PAP smears and 13% to intrauterine devices. There is a need for an organizational culture that will encourage reporting: direct reporting to the risk management department, reporting to field risk management referrals and reporting by entities not directly involved.

[CULTURE OF SAFETY IN THE HOSPITAL].

INTRODUCTION: The acute care hospital, with its hospitalization departments, diagnostic centers, outpatient clinics, operation rooms and intensive care units, is a very complex industry with the goal of taking care of patients in every stage of their disease, starting with prevention and continuing with diagnosis and treatment. Diagnosis and treatment processes have many stages; most of them depend on high technology and advanced science. Studies in the USA demonstrated 98,000 to 241,000 cases of mortality due to medical errors and complications, third place after mortality due to cardiac diseases and cancer. The quality of treatment is obviously important. The more effective the drug, the higher the influence on disease activity and the better the recovery. Drug safety is not always appreciated and taken into account. The medical team is requested to notify on every mistake, adverse event and sentinel event on the one hand and "nearly missed" cases on the other hand. The reports are very important for system learning. We believe that by changing the system we can prevent many kinds of human errors. We believe that "to err is human", we are not looking for "blame or shame", but want to prevent the next potential mistake. According to the hospital vision, working plans and projects, an annual risk-management plan is needed. This plan has 3 parts: retrospective, prospective and continuing claims and complains assessment. A good annual, comprehensive risk-management plan will protect the patients and lead to a decrease in morbidity and mortality.

Extension to 'combined SNA and LDA methods to understand adverse medical events': Doctor and nurse perspectives.

BACKGROUND: Physicians and nurses are responsible for reporting medical adverse events. Each views these events through a different lens subject to their role-based perceptions and barriers. Physicians typically engage with diagnosis and treatment while nurses primarily care for patients' daily lives and mental well-being. This results in reporting and describing medical adverse events differently. OBJECTIVE: We aimed to compare adverse medical event reports generated by physicians and nurses to better understand the differences and similarities in perspective as well as the nature of adverse medical events using social network analysis (SNA) and latent Dirichlet allocation (LDA). METHODS: The current study examined data from the Maccabi Healthcare Community. Approximately 17,868 records were collected from 2000 to 2017 regarding medical adverse events. Data analysis used SNA and LDA to perform descriptive text analytics and understand underlying phenomenon. RESULTS: A significant difference in harm levels reported by physicians and nurses was discovered. Shared topic keyword lists broken down by physicians and nurses were derived. Overall, communication, lack of attention, and information transfer issues were reported in medical adverse events data. Specialized keywords, more likely to be used by a physician were determined as: repeated prescriptions, diabetes complications, and x-ray examinations. For nurses, the most common special adverse event behavior keywords were vaccine problem, certificates of fitness, death and incapacity, and abnormal dosage. CONCLUSIONS: Communication and inattentiveness appeared most frequently in medical adverse events reports regardless of whether doctors or nurses did the reporting. Findings suggest feedback and information sharing processes could be implemented as a step toward alleviating many issues. Institutional management, healthcare managers and government officials should take actions to decrease medical adverse events, many of which may be preventable.