Common Factors | Fall 2022

Constellations Top Risk Drivers

In-depth analysis reveals the allegations and contributing factors most likely to affect your bottom line.

The top risk drivers identified are:

In an analysis of Constellation’s medical professional liability (MPL) insurance claims from its member companies, Constellation has identified what it considers to be the five most significant drivers of risk—and loss for health care organizations. Fortunately, many of the contributing factors identified within these drivers are amenable to changes that can reduce risk in the future. Paying attention to risk management— especially in these areas—can make a meaningful difference for your organization on multiple levels. In response to this vital information about what drives risk, organization-wide changes to your systems and processes can increase loyalty and satisfaction for care team members, as well as for administrators. Care teams that have better processes in place, who experience a more just culture that is transparent and fair, and who are able and willing to speak up to reduce or mitigate errors, are more likely to help the organization hold up and fulfill goals around risk management. Ideally, risk management leads to better care, which can also have a positive effect on patients, senior living residents and their families. More transparency, clear and open communication and increased respect and trust between caregivers and those receiving care can impact satisfaction, leading naturally to better retention of patients and senior living residents—and perhaps even impacting an organization’s reputation in its community.


The top risk drivers identified are:

  • Surgical processes
  • Diagnostic processes
  • Obstetrical (OB) processes
  • Falls reduction
  • Team communication

These top drivers have been drawn from the overall top malpractice allegations from Constellation member companies, as determined by occurrence and cost, with the exception of team communication, which is a top contributing factor in all claims. As you can see in the “Top Drivers of Risk” figure to the right, OB processes was picked as a top driver, because while OB claims were less frequent, the average cost of those claims was disproportionately high—driving the OB category to have the third highest costs of all allegations. Among all allegation categories, the top contributing factor driving risk for all claims is communication breakdowns—35% of all claims include one or more communication breakdowns. Team communication—which includes communication breakdowns among care team members—is a subset of communication breakdowns overall. Of all the communication breakdowns that lead to MPL claims, those within the care team are the most expensive events. Among all allegations, team communication factors account for a total cost of $151 million.



Surgical Allegations

  • 1 in indemnity cost (tied with diagnostic allegations)
  • #1 in occurrence
  • Top allegations in surgery claims involve:
  • Surgical performance issues
  • 55% of surgical claims
  • 54% of surgical claim costs
  • Surgical patient management issues
  • 33% of surgical claims
  • 41% of surgical claim costs

Diagnostic Allegations

  • #1 in indemnity cost (tied with surgical allegations)
  • #3 in occurrence
  • 43% of diagnostic error claims occur in the outpatient setting
  • 49% of diagnostic error claims result in high-severity injury/harm

Team Communication

  • 35% of Constellation’s claims involve breakdowns in communication
  • Within the care team, communication breakdowns account for 67% of costs and 43% of claims
  • 50% of team communication claims result in high-severity injury/harm

Obstetrical Allegations

  • #3 in indemnity cost
  • OB claims have the highest average indemnity per claim
  • Top allegations in OB claims involve:
  • Delay in treatment of fetal distress:
  • 33% of costs; 19% of claims; 97%
  • resulted in permanent injury or death
  • – Improper management of pregnancy:
  • 6% of costs; 17% of claims
  • – Improper performance of vaginal delivery: 7% of costs; 17% of claims
  • #7 in occurrence

Falls Allegations

  • #6 in indemnity cost
  • Falls happen frequently in:
  • Hospital patient rooms
  • Senior living centers
  • – Account for 49% of claims and 55% of costs
  • #4 in occurrence
  • Communication breakdowns and failure to follow organizational falls reduction policies contribute to the majority of fall allegations

Presenter Lori Atkinson

LORI ATKINSON, RN, BSN, CPHRM, CPPS
Content Manager and Patient Safety Expert

Presenter Lori Atkinson

LIZ LACEY-GOTZ
Common Factors Editor