INTRODUCTION

The greatest challenge facing health care providers in the 1980s is to preserve and improve the quality of health care services in the face of diminishing resources. A major part of this challenge is the prevention of financial losses from litigation. These losses may be in the form of direct costs, such as legal fees and insurance premiums, or indirect costs, such as unnecessary medical tests performed in a misguided attempt at "defensive" medicine. Whether direct or indirect, such losses reduce the resources available for necessary patient services. The purpose of this book is, through the systematic identification and management of the legal risks of health care delivery, to help prevent this waste of resources. This approach to the prevention of financial loss is part of the practice of preventive law.

Preventive law, like preventive medicine, is a multidisciplinary specialty. Just as the preventive medicine specialist must be skilled in both the mechanisms of individual illness and the epidemiologic techniques for the evaluation of the health of populations, the preventive law specialist must be versed in both the specific laws and the quantitative methods for the evaluation of risks. It is difficult to identify legally significant events in the mass of data that accompanies modern health care delivery. Once these events are identified, however, their management requires a balance of legal and medical standards. To identify legally significant events, a provider must have an effective management control system, an in-depth knowledge of the applicable laws and professional standards, and a systematic approach to the evaluation of the information flow.

This first chapter outlines the requirements of a management control system and provides an overview of the use of computer-based techniques to analyze medical information. The discussion of management control systems includes an examination of techniques for evaluating existing risk management and quality assurance programs.

The structure and objectives of risk management and quality assurance programs are detailed in Chapters 2 and 3. This information will aid in the correction of problems that are identified during evaluation of the quality assurance programs. The goal of the evaluation is to integrate risk management and quality assurance into a unified quality control program. This integration will eliminate the costly duplication of effort that accompanies separate risk management and quality assurance programs. More importantly, such an integration will lead to a more reliable system through the elimination of ambiguous lines of authority.

The remainder of the book deals with specific problem areas in medical quality control. For each area there is a discussion of the applicable legal and professional standards, examples of common problems and their solutions, and, where applicable, suggestions on the use of computer techniques to aid in the management of the problems. The examples are drawn from the authors' personal experience in medical research, direct health care delivery, medical law, and preventive medicine and are based on actual problems encountered in health care delivery. The solution of some of the problems may seem obvious, but it is precisely those problems with obvious, but it is precisely those problems with obvious solutions that, if mishandled, result in the largest losses.