Common Factors spoke to Constellation Chief Medical Advisor Carolyn Anctil, MD, FACEP, about her new role guiding the Clinician Peer Support Program and participating in the claim, risk mitigation and underwriting teams. These responsibilities leverage Anctil’s more than 25 years working as a board-certified emergency medicine physician, and 10 years working in quality assurance for Utah Emergency Physicians on staff at Intermountain Healthcare hospitals in the Salt Lake City area.
Common Factors: How have you been influenced by your 10 years in quality assurance for Utah Emergency Physicians, most recently as Director of Quality for the past 2 ½ years? Carolyn Anctil, MD: In my first several years on the quality committee, we would discuss the physician’s care while we asked them to wait outside the room. As part of our evaluation, we would rate their care on a scale. When I took on the role of director of the committee, we moved to a new format in which we invited the physician to the table—or online meeting call— while we discussed and learned from the story of their care. And we stopped rating their care. It allowed for us, as a group of providers, to be more supportive and collaborative. I believe this cultural shift has created opportunities for physicians to feel comfortable to share information about errors or potential harm events.
CF: Do you see parallels between how you work with the quality committee in Utah and how Constellation works with insured clinicians?
CA: Absolutely. As a physician insured by one of Constellation’s member companies, I learned of their efforts with the early intervention team and the HEAL program, which seemed to come about at the same time we were intuitively making some of the same realizations in our committee in Utah. We were both realizing the importance of respect and collaboration through this process, the importance of not judging care or creating a fear of retaliation. This all naturally led to more open dialogue within our physician group. And it helped us intervene earlier to help resolve potential issues. It also helped us learn as a group from the errors or harm events that occurred, hopefully leading to preventing more of the same problems in the future.
CF: How has 25 years in emergency medicine prepared you for this role at Constellation?
CA: Emergency physicians have the pleasure of caring for individuals at the most vulnerable and high-risk times in their lives. In this role, I’ve had the opportunity to interact and learn from almost every specialty. Working full time for 25 years in Utah’s busiest hospital has afforded me the opportunity to care for patients from all walks of life with an incredibly varied presentation of issues. I have seen medical issues that did not necessarily go as expected for the patient, and delays in diagnosis from well-intentioned physicians. Intermountain Healthcare is an excellent partner in harm reduction. I recognize how fortunate I am to work in such an amazing hospital system, particularly when we evaluate harm events from other hospital systems that are still developing their support systems.
CF: How do you see your role as Chief Medical Advisor in relation to the previous role held by Dr. Laurie Drill-Mellum for the past several years?
CA: I am still learning about the incredible work that my predecessor accomplished. She worked for Constellation during a time of incredible change, where she was able to move from a culture of “deny and defend” to one of support. It is my intention to continue to foster this work. It would be wonderful if whenever harm events occurred, that caregivers and patients felt comfortable—and had the skills—to communicate without fear of legal ramifications. Harm events will continue to occur; unfortunately, this is simply the nature of living, illness and unexpected, unpredictable outcomes. But there is always the opportunity to change how we respond to and support our caregivers and our patients. I believe that supporting a healthy response to harm events will ultimately lead to important system changes that can further reduce errors.
CF: Do you believe that it’s important for Constellation to have medical leadership? CA:
I believe it’s valuable for Constellation’s underwriters, claim examiners and risk consultants to have a physician who is readily available to offer advice or provide context. I’ve had some great conversations about various risks with the teams at Constellation, and I’ve attended large loss and claim meetings. Certainly, all of these cases have been evaluated by experts in the specific field, but my work as an emergency physician can bring perspective and clarity to some medical questions that inevitably arise as cases are further developed and discussed.
CF: What other experiences in your work, and in your life, will be helpful in your new role?
CA: Having worked for the same group for 25 years, I have a close relationship with many of my partners. We have been through a lot together, particularly in the last two years with COVID-19. During the pandemic, I have learned so much from my fellow physicians and nurses—about compassion, patience and the privilege of caring for others. I’ve definitely cried more at work in the past two years than in my entire career. I feel such great sorrow for all the lives that have been lost and directly affected by COVID-19. The stress of the pandemic has led to a suicide in my group of physicians, and to early retirement for several others. I am definitely kinder than I was two years ago.
CF: What do you look forward to in this new role?
CA: I love learning. I truly believe that what Constellation has started is the best way forward for practicing physicians and other clinicians. I would love to see a day when a harm event occurs and we all feel that the best solution is to contact Constellation for a quick and supportive resolution. No more time spent denying and defending. In this role, I hope to continue cultivating a culture in which we can all learn something new every day. If we all recognize that medicine is an art and a practice to be learned from our mistakes, perhaps physician burnout would not be so great. And perhaps the joy and hope that we all felt when beginning our medical careers can be rekindled.
Common Factors Editor