Пациентский экстремизм: инструкция по выживанию для клиник – часть 2

Сергей Мельников, руководитель группы клиник стоматологической сети «ПрезиДент», поделился мерами профилактики пациентского экстремизма, которые они использует в своей работе.

В первой части статьи юрист Алексей Горяинов дал подробную инструкцию для клиник, как бороться с потребителями-экстремистами.

Пациентский экстремизм

Пациентский экстремизм – это намеренная попытка получить от клиники материальную выгоду с помощью угроз (обратиться в СМИ, написать жалобу) или судебных исков.

Доля пациентского экстремизма растет. Лет пять назад мы время от времени сталкивались с жалобами от пациентов. Как бы прекрасно клиника ни работала, всегда будут пациенты, которым что-то не понравилось. В основном эти жалобы поступали от женщин 45+, часто неработающих. Судя по эмоциям и процессу взаимодействия, для некоторых из них это была форма досуга.

Года три назад картина изменилась. Жалобы начали писать работающие мужчины 30+. Но главное – значительно изменились суммы исков. Раньше суммы была сопоставимы со стоимостью лечения, теперь они выросли в 10-15 раз за счет компенсации морального вреда и иногда измеряются миллионами рублей.

В конфликтной ситуации мы всегда стараемся все решить полюбовно, в досудебном порядке. Не занимаем жесткую позицию, идем навстречу. Всегда проще договориться, чем идти в суд. Но все чаще сталкиваемся с людьми, которые приходят с намерением получить лечение, вернуть за него деньги и еще заработать на клинике. Раньше это были единичные случаи, теперь они измеряются десятками.

Типы претензий

Есть категория клиентов, которые считают вымогательство нормальной практикой. Например, пришла к нам пациентка и сообщила, что пишет жалобу на кондитерскую фабрику. По ее версии, она ела конфету, в которой попалась косточка, коронка попала на косточку и сломалась. Женщина просила нас оценить нанесенный ущерб и дать соответствующее заключение. Мы отказались, так как клиника может только подробно описать текущее состояние ротовой полости, но не оценить ущерб. При осмотре выяснилось, что металлокерамику пациентка поставила пятнадцать- двадцать лет назад. Коронки пришли в негодность и могли сломаться от малейшего давления. Пациентка заявила, что хочет лечиться у нас. Естественно, высока вероятность, что после лечения такой человек подаст в суд и на стоматологию.

Этот тип людей обычно обращает особое внимание на заполнение документов, иногда отказывается подписывать некоторые бланки, пропускает необходимые приемы. Делает все, чтобы затруднить возможные следствие и судебный процесс.

Вторая группа пациентов – это те, кому что-то в лечении не понравилось. Они вернулись домой, рассказали, и кто-то из знакомых посоветовал им подать в суд и получить компенсацию. Это довольно большая группа. Например, у нас был пациентка, которая прошла большое комплексное лечение. Через несколько лет вернулась на профилактический осмотр. Кто-то ей что-то неосторожно сказал. Она задумалась о том, что лечение можно было провести по-другому, подключились юристы, и она запустила судебный процесс на огромную сумму компенсации морального вреда. Клиника этот суд выиграла, но ушло много сил и нервов.

К сожалению, есть и обратная ситуация, когда пожилые люди насмотрятся репортажей о мошенниках в частных клиниках, приходят и боятся подписывать договор о лечении. Администраторы должны подробно рассказать, объяснить, зачем эти документы нужны, убедить, что это не попытка снять с себя ответственность.

Раньше можно было смотреть заполнение документов сквозь пальцы, но не теперь. Формальность превратилась в гарантию безопасности клиники и врача. Если документов нет, клиника сильно рискует.

Принципы защиты, которые мы выработали

  • Необходимо полно и грамотно заполнять документацию, прежде всего договор на лечение.
  • Пациент должен подписать все информированные добровольные согласия на каждую манипуляцию: хирургию, имплантацию, осмотр и пр.
  • Врач и пациент должны согласовать полный план лечения перед началом лечения и оговорить сроки, нюансы и риски. Если что-то изменилось, обязательно нужно подписать новый план лечения. Пациент должен подтвердить, что согласен со всеми нюансами, в том числе выбранной формой и цветом протезов, коронок, имплантов.
  • Клиника должна вести фотопротокол всех процедур. Это важно и для медицины, и для контроля качества, и для юридической безопасности. В некоторых клиниках стоит вести видеопротокол.
  • Обязательно нужно делать записи в карте, если пациент не приходит на необходимый осмотр или не выполняет предписания. Сталкиваемся с ситуациями: пациента предупредили о каких-то последствиях, он должен прийти на осмотр. Ему звонят и приглашают, он игнорирует. Потом возвращается через два года и заявляет, что лечение проведено некачественно.
  • Необходимо полно и грамотно заполнять дневниковые записи в карте. Трех слов уже не хватит, нужна полноценная запись с результатами осмотра, жалобами. Эти сведения врач должен заполнять при каждом визите.

Для этого мы постоянно обучаем сотрудников заполнять документы. Юристы компании регулярно проводят семинары, также используем наработки внешних юристов, делаем образцы заполнения. Программисты доводят МИС до состояния, когда врач не может провести лечение, не заполнив документацию.

Контроль качества

Лучшая профилактика экстремизма – это контроль качества услуг. У нас несколько этапов контроля качества. Все терапевтические, ортодонтические и имплантологические виды помощи проходят многоступенчатую систему контроля. Медицинские карты, фотопротоколы и снимки проверяют главврач и заведующие отделениями.

Уровнем выше работает комиссия экспертов (медицинские директора других клиник или сторонние врачи, имеющие ученую степень и звания). Комиссии разделены по направлениям работы и контролируют качество услуг в каждой области. При спорных и судебных ситуациях мы обращаемся в НИМЭ (Национальный Институт независимой Медицинской Экспертизы). Они проводят независимую экспертизу, которую принимают судебные органы.

Работа с жалобой

Когда жалоба поступила, мы разговариваем с пациентом и пытаемся понять суть претензий. Общаются поэтапно врач, главврач, заведующим отделением или директор, затем руководитель группы клиник или медицинский директор. С самого начала к процессу подключаются юристы. Задача – определить реальную потребность. Возможно, мы не донесли информацию правильно, что-то неправильно объяснили, поэтому возник конфликт.

Если претензия хоть чем-то обоснована, идем навстречу и ищем способы помочь. Если же пациент хочет получить выгоду, мы привлекаем сторонних экспертов. Недавно начали привлекать медиаторов – людей, которые помогают урегулировать конфликты в досудебном порядке. Работает отлично.

До суда нам удается решить абсолютное большинство конфликтов. Несмотря на экстремизм, подавляющие большинство пациентов – это обычные люди, которые хотят получить помощь и лечение. Когда клиника идет навстречу, помогает и признает ошибки, они готовы договориться и отозвать претензии.

Профилактика

Хорошая профилактическая мера – оперативный сбор и обработка обратной связи. Каждому пациенту после приема мы отправляем ссылку с анкетой оценки NPS по системе «Zabota 2.0». Если клиент ставит оценку ниже 7, тут же урегулируем ситуацию. В сообщении ему также предлагается оставить отзыв. Процедура отсекает огромную долю негатива до того, как она куда-то выплеснулась.

На все негативные отзывы в интернете и публикации блогеров отвечаем открыто и честно, объясняем ситуацию, рассказываем о предпринятых мерах. Год назад был на конференции, где выступали спикеры из клиники Мэйо. У них интересный подход к врачебным ошибкам. Первый, кому они о ней сообщают, это сам пациент. Тут же начинается расследование. Отдельная группа психологов работает с врачом, который ошибся.

Например, произошел случай, медсестра ввела эпидуральную анестезию в капельницу, пациент погиб. Медсестре долго помогали отойти от этой ситуации, собралась рабочая комиссия, которая сразу начала думать, что сделать, чтобы предотвратить подобное. Клиника изменила наконечник у эпидуральной анестезии, чтобы его нельзя было вставить в капельницу – минимизировала человеческий фактор. Мы стараемся перенять эту открытость. Сейчас на внутренних конференциях в клинике врачи готовят отчеты об ошибках, чтобы передать опыт другим. Постоянно редактируем протоколы работы, чтобы снизить все риски.

В первой части статьи юрист Алексей Горяинов дал подробную инструкцию для клиник, как бороться с потребителями-экстремистами.

Приветствую! Опубликуйте материал о своём опыте в медицинском маркетинге в нашем Блоге. Для этого напишите мне на k.magomedshafieva@napopravku.ru

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