title: The role of informed consent in patient complaints: Reducing hidden health system costs and improving patient engagement through shared decision making.
abstract: BACKGROUND
  Patient complaints about physicians are strongly associated with malpractice risk. Physicians at high risk for lawsuits tend to have poor communication skills and are more commonly the subject of patient complaints about communication issues. If a malpractice action does not arise, patient complaints nonetheless represent significant prelitigation transaction costs for the healthcare system that have not been previously quantified. Informed consent complaints represent a unique constellation of clinical communication skills clearly tied to malpractice risk. The goal of this study was to measure institutional resource consumption allocated to informed consent (IC) complaints, which are both costly and preventable.
  
  
  METHODS
  We compared IC complaints to other complaints about medical care in a single medical center in the United States, estimating the absolute and relative burden of IC deficiencies within this healthcare system.
  
  
  RESULTS
  Resource consumption for the resolution of IC complaints far exceeded their proportional representation of complaints, representing half of all complaints, while disproportionately absorbing two-thirds of staff time devoted to complaint resolution.
  
  
  CONCLUSIONS
  Complaint resolution represents an unrecognized remediable cost and an underappreciated opportunity for reducing waste in healthcare. We suggest that healthcare systems can reduce costs and elevate their patient-centered care practices by improving patient-provider communication during medical decision making via engagement strategies such as shared decision making.
authors.affiliation: University of Washington Medical School.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Posner
authors.affiliation: Healthcare Risk Management.
authors.forename: Julie
authors.initials: J
authors.lastname: Severson
authors.affiliation: University of Washington Medical School.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Domino
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000458:organization & administration*; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D014481:United States