What are the requirements for critical incident reporting systems (CIRS) for hospitals in Germany?
German law requires implementation of internal CIRS systems. Hospital insurers usually require and provide implementation of cross-entity CIRS systems.
Do patients and their families report in CIRS systems?
CIRS is open to patients and families, but they generally don’t use that system. Instead, they use the separate patient-complaint system.
Is information from CIRS systems ever used in medical malpractice litigation?
I cannot think of a single event where a judge looked into a CIRS system.
In addition to CIRS, do you think the law should require mandatory error reporting systems?
No. More aggression towards physicians equals lower patient safety culture. We must choose between fear and safety.
Are there statistics on how many people die from medical errors each year in Germany?
We shouldn’t focus so much on statistics. We already know patient safety is a problem. It’s better to focus on fixing the problem.
What steps can we take to fix the problem?
It is impossible to measure patient safety, but you can measure patient safety culture. We must reach humans in the system first. There must be a paradigm shift in safety culture. In order to prevent errors, we must first be able to talk about and learn from errors. In addition, the press can help change patient safety culture on a national level.
On the organization of modern healthcare systems:
You can look at three differently funded healthcare systems: state-sponsored healthcare in the U.K., pure market-based healthcare in the U.S., and Germany’s hybrid system. Regardless of how the systems are financed, they have the same problems, because they all share the same assembly line organization. The focus is on cost and not quality. Money can be made with very bad healthcare. We need to reorganize healthcare infrastructure to a value-based system. Patient safety is an important part of optimizing healthcare.
There are two things needed to bring an organization back to life. First, we must focus on patient outcomes. Second, we must turn the assembly line system into a learning system. Every healthcare system needs to ask itself, “How does our hospital learn?”
What is the highest award that you are aware of in a medical malpractice case?
11-12 million for a birth injury case (this includes special and general damages).
Tell me about Germany’s out of court resolution methods for medical malpractice cases.
The Physicians’ Chambers in the different states run expert arbitration boards that can hear patients’ complaints of medical error and issue an opinion. The process is free for both parties and non-binding. The arbitration proceedings stop the statute of limitations from running. The board makes a determination on liability and causation, and sometimes recommends an award amount. A retired higher court judge with a specialty in medical law presides over the board with the assistance of medical experts.
What are the standards for expert opinions?
An expert must have evidence from a peer-reviewed scientific journal. He or she cannot just render a personal opinion regarding the standard of care.
What inspired you to get into politics?
As a surgeon, I observed that politicians made bad decisions affecting people’s health, but were not held accountable. They didn’t have to go to court to answer for their decisions. If politicians do not care about patient safety, then the very basis of society is threatened, because the government’s job is to protect people from great harms.
On what he considers one of his greatest accomplishments in the promotion of patient safety culture in Germany:
In 1995, I began looking for patterns in medical errors. That same year, I was elected Vice President of the Berlin Chamber of physicians. In 2005, I was able to pass a resolution on patient safety at the German Medical Assembly with unanimous support. As far as I know, we are the only medical assembly to pass such a resolution.
What are the goals of patient safety work?
One: promotion of patient safety culture. Two: improving competence though medical education reform. Both must be a collaborative interdisciplinary effort.
What role do you see for someone like me in patient safety work?
You can become the best medical malpractice lawyer out there, or you can use your legal knowledge to work with healthcare organizations to improve patient safety, or you can become a politician and advocate for better healthcare policies.