Q&A: Bob Hanscom on learning from malpractice data, partnering with clinicians and the future of patient safety

Hanscom headshot

Robert Hanscom, J.D.

Bob Hanscom, J.D., is retiring this week after a nearly 30-year career championing patient safety improvement. He has been Vice President of Risk Management and Analytics at Coverys since 2013 and earlier held similar positions at CRICO and CRICO Strategies. He was Vice President of Clinical Services at Lahey Clinic from 1993 to 1998 and prior to that practiced law.

Betsy Lehman Center: In 2016 you observed, “We have failed to identify which data sets provide the best signals” for risk in health care delivery. What would you say now?

Bob Hanscom: There is now a higher level of awareness that health care lives in the world of fragmented data sets, but it’s still a work in progress. When I make presentations, I emphasize the words “signal data” to help people and organizations understand that they can use data to learn where they are vulnerable, where they're at greatest risk of causing patient harm and what they can do proactively to lessen risk.

One of my missions has been to elevate the lessons offered by malpractice data, but it’s sometimes been a struggle. Questions always arise about the statistical significance of the data. People say, “Why should we pay attention to that case?” or “This case is a fluke; it’s not going to happen again.” My response has always been that if we ignore the lessons from malpractice cases, we do so at our peril.

We need to make sure that in addition to understanding what drives these tragic events, we’re coding the data, aggregating factors, and making sure it’s all positioned to help prioritize where to focus our attention and what actions to take for patient safety. In other words, it’s critical that we accurately capture the learnings from these events.

It has taken a lot of heavy lifting to get malpractice data into the mix of signal intel that needs ongoing attention. Historically, data of this type has been kept segregated from other data sets; there has been a fair amount of reluctance to make it more accessible. But I have always said that malpractice cases offer unique insights that become even more meaningful when linked with other, more “real time” data sets. Adverse event data, patient complaints, root cause analyses, and serious reportable events. All need to be drawn into a central environment and normalized so they can live together to provide actionable — and accurate — insights for health care leaders as they focus on patient safety priorities. The work to bring these data sets together is still in its infancy. It’s my great hope that it will continue forward.

I think most malpractice carriers around the country now would also say they have a patient safety mission. It has become the language of the industry, which I think is tremendous.

Betsy Lehman Center: How would you describe the role of medical liability carriers in helping improve safety culture and practices to prevent harm?

Bob Hanscom: Working in health care administration in the mid-1990s, I saw and heard concerns and fears among physicians about being sued. When I moved into the malpractice defense space, first at CRICO and then at Coverys, their fears were very fresh in my mind. Working for a malpractice carrier, I wanted to make sure that the practices, clinicians and hospitals we covered understood that they had a partner, that the carrier would protect and defend them. But how could we best help them stay on course in delivering good care? That, many years ago, was the impetus for creating a rich environment of actionable data. Ultimately, while highlighting the negative — the malpractice cases — these data pointed toward potential best practices, ongoing education and other approaches that are and continue to be highly responsive to the root-cause drivers of these events.

As we expressed assurance that we would defend them and, as we provided more and more resources over the course of many years, it seemed to have had an impact on defensive medicine. I don’t have data to confirm this but can say, at least anecdotally, that doctors talk about the need for defensive medicine far less than they did 20 years ago.

When I was at CRICO, we decided that we weren't in business just to give out risk management advice. Our mission was higher than that; it was a patient safety mission. Similarly, at Coverys, we tell our clients that we’re here to help them provide the safest care possible, and we back that up with myriad resources.

I think most malpractice carriers around the country now would also say they have a patient safety mission. It has become the language of the industry, which I think is tremendous.

Betsy Lehman Center: How have you defined success in your work over the years?

Bob Hanscom: My goal has always been to make a difference. If I’m going to invest my time and the time of my staff, I want to know that we are doing things that matter, whether we know that through our analysis of the data or through constituent conversations.

I also like to think that I’ve helped change the way we talk about risk and patient safety. Earlier, I talked about “signal data.” I first started using that term 15 years ago. At the time, I had observed other speakers get into awkward situations with audiences of combative physicians. Malpractice data often was presented in ways that doctors felt almost “indicted” them for the care they had been providing. The adversarial nature of those exchanges was not at all productive.

As I began my work in presenting malpractice data to groups of physicians, I saw an opportunity to be more positive when engaging with them. I told them I could pull signals out of our malpractice data but needed their help to evaluate the signal strength. Was something a weak signal? Or was it a moderate or even strong signal? If a case represented something that could actually happen again tomorrow and result in serious outcomes, we would collectively label it a strong signal. Then I would ask the physicians to lay out plans of action to address the problem we saw. The first time I did that was a big success. I kept using that approach and have seen others use it effectively, too.

In a lot of ways, I hope I’ve impacted the way we speak to one another. I try to tell clinicians, “We're all in this together. Let's try to figure this out.” That’s been an important shift.

Betsy Lehman Center: Going into retirement, do you have plans you’d like to share with our readers?

Bob Hanscom: I do have some things planned beyond traveling and enjoying time with my family. I've always been a writer and have had a working script for a novel in my head for some time. I look forward to working on that. I also am by nature a historian and want to write a history of my own family. But this will be something more than names and dates. It will focus more on storytelling — family lore that should not be lost and could have broader appeal to the reader.

I also want to stay connected to the work we've done to support the movement toward a safer health care environment. We have so much work to do.

I would love to see us have a meaningful, national discussion about standardizing processes and the health care environment across the board. Other industries where safety is an issue don't allow variation in certain things. I don't want to oversimplify — health care is complex — but I think we've reached a point where we really need to take stock of this.

The current nursing shortage illustrates the problem. Traveling nurses find that care delivery processes are somewhat different at every institution, which increases risk of harm. I don't know why we put up with that.

I’d like to see health care make a significant effort to identify which processes are universally critical to the delivery of care and develop uniform standards — not just here in Massachusetts but across the country. That is why I think the Betsy Lehman Center and the Massachusetts Coalition for the Prevention of Medical Errors are so important. I wish every state had similar groups. A national coalition of these groups could join together and start doing this very important work.

I’m convinced we can drive unnecessary variation out of health care, but it will take leadership to help us get our arms around the problem. To whatever extent I can still contribute, that’s the sort of work I would actively support.


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