Last year, Vanderbilt Health extended to its three Regional Hospitals its programs for professional accountability based on monitoring of complaints from patients and co-workers.
“The addition of these programs to the Regional Hospital Division has been transformational,” said Adam Huggins, MD, MMHC, associate professor of Clinical Obstetrics and Gynecology and chief of staff, Vanderbilt Regional Hospital Division. “It has allowed us to bring an objective and data-driven process to improving professionalism and overall culture within the medical and hospital staffs.”
In 2019, Vanderbilt Health acquired its first community hospital, Vanderbilt Wilson County Hospital, and 2021 saw the acquisition of two more — Vanderbilt Bedford Hospital and Vanderbilt Tullahoma-Harton Hospital.
Angela Carter, DNP, RN, is chief nursing officer at VBCH.
“These programs foster patient-centered care by providing a kind, collegial and evidence-based approach to professional accountability,” Carter said. “We’ve quickly come to regard them as important parts of our high reliability journey.”
Efforts by Vanderbilt Health to manage medical malpractice costs and support clinical safety have long included the close tracking of unsolicited complaints about clinicians from patients and co-workers.
For any physicians and advanced practice providers — that is, nurse practitioners and physician assistants — who generate higher volumes of complaints, an escalating system of interventions starts with so-called peer messenger conversations, convened by a fellow clinician who has been trained to help colleagues understand the risks of disrespectful, unprofessional behavior.
“By flagging concerns early, these programs allow for timely interventions before minor issues can escalate into patient safety incidents,” said Marilyn Smith, DNP, MSN, RN, chief nursing officer, VTHH. “They help address disruptive behaviors that could undermine team cohesion and clear communication — both critical to safety and effective care delivery.”
This system for professional accountability is born of research from the Vanderbilt Center for Patient and Professional Advocacy (CPPA) and has been administered by the center since 2002. Under various contracts, CPPA has since exported the system to some 300 hospitals and physician groups around the country.
CPPA programs are driven by the center’s Patient Advocacy Reporting System (PARS) and Coworker Observation Reporting System (CORS), used in tandem to track complaints from patients and co-workers, respectively. PARS and CORS apply to physicians and advanced practice providers, while CORS also extends to nurses and residents.
VWCH adopted PARS and CORS in 2023 and 2024.
“Beyond helping to avoid malpractice claims and resulting reputational damage, these programs help promote a supportive and respectful workplace, which makes for better staff retention and morale while also supporting excellence in care, which is essential for our patients,” said Jeanne Yeatman, DNP, MBA, RN, EMT, chief nursing officer, VWCH.
Here are some research highlights of recent years from CPPA:
- Patients of surgeons with higher numbers of reports from co-workers about unprofessional behavior are more likely to experience complications.
- Patient and family reports about rude and disrespectful behavior can identify surgeons with higher rates of surgical site infections and other avoidable adverse outcomes.
- Trauma patients who received care from at least one admitting or consulting service with a high proportion of physicians modeling unprofessional behavior were found to be at a 24% increased risk of death or complications.
- At a multisite orthopedic practice in the Southeast, over the 12 years following implementation of PARS, malpractice claims costs for 42 high-risk clinicians fell by 83%, and for the overall practice, per-provider claims costs dropped by 87%.
For more information, visit the CPPA website.
