President Obama’s purpose was to stimulate the development of a range of innovative ideas that put “patient safety first and let doctors focus on practicing medicine.” The legacy of the PSML initiative is that it accomplished the goal of addressing the challenges of the current medical liability system taking a nontraditional approach. All parties involved in malpractice reform generally agree that doctors are troubled by—and patients and family members are not well served by—the current medical liability system. Evaluations of policy interventions (like damage caps, changes to the statute of limitations, and limits on attorney’s fees) have produced only equivocal findings; some studies suggest a positive impact on claims and costs, but others raise questions about basic fairness (e.g., if such changes cause injured parties to be unable to seek due compensation because they cannot find a lawyer).
The PSML initiative took a decidedly different approach. Instead of seeking legislative changes, it empowered States and health care organizations to think “outside the box” about solutions that would reduce preventable injuries, foster better communication between doctors and patients, and award compensation to injured patients in a timely and efficient manner.
Unfortunately, the quantitative results on the impact of the innovations reported here are equivocal as well. Some evaluations show an impact on patient safety and malpractice outcomes, but our confidence in these findings is limited by concerns about the underlying study designs. Nevertheless, the learnings from the PSML demonstration projects are immense and provide clear direction for AHRQ and the Nation to continue on the path initiated by the President. Much work has been done, and more work remains.