Between trust and risk how safe is our medical care?

Claims for Damages Due to Medical Malpractice in Germany

Number of reported medical errors and claims for damages  

• According to the “Report of the Expert Commissions and Conciliation Boards” by the German Medical Association, a total of approximately 10,200 requests for the review of suspected medical malpractice were submitted in 2022.
• Medical malpractice was confirmed in approximately 3,800 cases. This corresponds to about 37% of the cases reviewed. In approximately 2,100 cases, the error resulted in harm to the patient’s health, which established liability on the part of the physician or hospital.

Most Common Areas of Error

Amount of Damages Paid

• On average, doctors and hospitals pay between 50,000 and 100,000 euros in damages for confirmed cases of medical malpractice. However, this amount can vary significantly depending on the severity of the harm.
• In serious cases resulting in permanent damage, disability, or death, compensation payments can range from several hundred thousand to over one million euros.
• According to the German Insurance Association (GDV), total compensation paid for medical malpractice in 2022 amounted to approximately 400 million euros. This amount consists of compensation payments, pain-and-suffering damages, and annuity payments.

Insurance Claims

• Doctors and hospitals are generally covered by liability insurance, so claims for damages are often covered by insurance. The average number of insurance claims related to medical malpractice is approximately 15,000 to 20,000 cases per year.
• Cases in which lifelong follow-up costs must be covered are particularly expensive, such as in instances of medical malpractice that result in permanent disabilities.

Trends in Claims for Damages in Recent Years

• In recent years, the number of reported medical errors has remained relatively stable, but the average compensation amounts have risen. This is because serious errors, in particular, are being better documented, and the claims for damages are correspondingly higher.

What are the latest findings and developments regarding patient safety?

In recent years, the field of patient safety has continued to evolve through various research projects, studies, and initiatives. Here are some of the latest findings and developments in the area of patient safety:

The Importance of Digital Transformation

• The digital transformation of the healthcare system is playing an increasingly important role in improving patient safety. Electronic health records (EHRs), telemedicine, and digital error reporting systems enable more efficient documentation, communication, and error prevention.
• Studies show that implementing electronic medication plans can reduce the risk of medication errors by up to 60%, as interactions are better identified and dosing errors are avoided.

Improving Communication and Teamwork

• One of the most common causes of medical errors is communication problems among healthcare staff. Recent studies emphasize the importance of standardized handoff protocols and regular communication training to prevent misunderstandings and information gaps.
• “SBAR” (Situation, Background, Assessment, Recommendation) is a communication model now used in many facilities to convey information clearly and in a structured manner.

Patient Involvement and Safety Culture

• There is growing evidence that involving patients in the treatment process enhances safety. Patients who actively ask questions and participate in decision-making help identify and prevent errors.
• Healthcare organizations that foster an open error culture, in which errors and near misses can be reported without fear of punishment, have significantly lower error rates. This insight has led more and more facilities to implement a “CIRS” (Critical Incident Reporting System).

Artificial Intelligence (AI) and Data Analytics

• Artificial intelligence (AI) is increasingly being used to identify risks at an early stage. For example, AI-powered systems can monitor patients’ vital signs in real time and flag anomalies early on, which supports staff in their decision-making.
• AI analytics make it possible to evaluate large volumes of patient data and thus identify potential risk factors for medical errors.

Nosocomial Infections

• Recent studies show that infections occurring in hospitals (nosocomial infections) still pose a significant safety problem. However, new strategies—such as increased use of hand sanitizer, the implementation of strict hygiene protocols, and the use of UV disinfection technologies—have led to a measurable reduction in these infections. Personal protective equipment and disinfectants are essential tools for healthcare workers to prevent potential nosocomial infections.

To which facilities do these findings apply?

The findings mentioned above for improving patient safety apply to a wide range of healthcare facilities:

Hospitals: Hospitals are particularly vulnerable to patient safety risks because complex medical procedures are performed there and many different departments interact. The use of checklists, digital documentation systems, and error reporting systems is especially important here.

Medical practices and outpatient facilities: Outpatient facilities also face risks of medical errors. Here, accurate documentation of patient history, communication between different physicians, and the safe prescribing of medications play a major role. Error-reporting systems are also increasingly being implemented in this sector.

Long-term care facilities: In nursing homes and assisted living facilities, medication errors and falls are common safety issues. Digital medication plans, training for care staff, and fall prevention measures help improve safety.

Rehabilitation facilities: In rehabilitation centers, where patients often receive long-term care, accurate documentation and continuous monitoring of the rehabilitation process are crucial for patient safety.

Pharmacies: Pharmacies also contribute to patient safety by checking for drug interactions and advising patients on proper medication use. Digital systems help prevent errors in dispensing medications.

Telemedicine services: With the increasing use of telemedicine, patient safety standards must also be adhered to in this area. The confidentiality of patient data, accurate diagnoses based on digital data, and clear communication with patients are crucial.

What measures are currently being taken?

Error reporting systems described in more detail

Error reporting systems are key tools for recording and analyzing treatment errors and near misses. These systems are designed to encourage healthcare personnel to anonymously report errors or near misses (situations that nearly resulted in harm) without fear of sanctions or negative consequences. The goal is to learn from these incidents and implement systematic improvements.

• Examples of error reporting systems:
  • CIRS (Critical Incident Reporting System): One of the best-known error reporting systems in Germany is the “CIRS – Critical Incident Reporting System.” It is used in many hospitals and enables staff to report critical incidents, which are then analyzed anonymously. The insights gained are used to identify safety gaps and develop preventive measures.
  • PaSIS (Patient Safety Information System): This system is a nationwide service available to both outpatient and inpatient healthcare facilities. It enables cross-sector reporting of near misses and critical incidents, thereby facilitating intersectoral learning processes.

Patient Safety Training 

Regular training sessions are a key component in raising medical staff’s awareness and competence regarding patient safety. These sessions help change the culture surrounding errors, identify risks early on, and take appropriate action.

• Training Content:
  • Simulation training: Realistic simulations are used to reenact typical high-risk situations. Medical staff learn to handle potentially dangerous situations—such as emergencies or the use of new technologies—in a safe environment.
  • Communication training: Communication errors are one of the most common causes of medical errors. Communication training helps medical staff convey information clearly and precisely, especially when transferring patients from one department to another.
  • Safety Awareness and a Culture of Learning from Errors: Training sessions emphasize the importance of reporting errors and learning from them, rather than covering them up.

Checklists and Standardized Workflows

Checklists and standardized workflows are effective tools for reducing human error. They ensure that all necessary steps in a treatment process are followed and minimize the risk of overlooking important details.

• Examples of checklists:
  • WHO Surgical Safety Checklist: This checklist comprises several sections that must be completed before, during, and after a surgery. These include, for example, verifying the patient’s identity, the surgical site, and the availability of instruments.
  • Medication checklists: These checklists help verify the correct medication dosage, administration time and method, as well as potential interactions.
• Standardized Workflows: These are established processes that all staff members must follow. Examples include protocols for handling high-risk medications or established procedures for patient identification.

Modern technologies such as the electronic health record (eGA)

The electronic health record (eHR) is a digital system that centrally stores and makes accessible all of a patient’s important health information. It offers many advantages in terms of patient safety:

• Features of the electronic health record:
  • Centralized access to patient data: Doctors and nursing staff can access important information—such as diagnoses, medication plans, allergies, and previous treatments—at any time and from anywhere. This reduces the risk of misdiagnoses and medication errors.
  • Medication Plans: The eGA allows users to view current medication plans and identify potential interactions, which is particularly important for patients taking multiple medications.
  • Reminder features: Patients are notified of upcoming preventive screenings, vaccinations, or doctor’s appointments, which improves disease prevention and treatment.
  • Safety Alerts: In cases of contraindications, allergies, or potential medication errors, automatic alerts can be generated to notify medical staff of possible risks.

Projects to Improve Patient Safety

• Alliance for Patient Safety (APS): The APS advocates for improved patient safety at the national level and develops guidelines, recommendations for action, and training materials for medical staff. In addition, the APS organizes the annual “German Patient Safety Award,” which honors innovative projects.

• “Safer OR” – Surgical Safety Project: This project aims to increase safety during surgeries by introducing standardized checklists and workflows. The “Safer OR” project has helped reduce complications during surgeries.

• “Working Together for Greater Safety”: A project that encourages patients, family members, and healthcare professionals to collaborate and work together to ensure greater safety in the healthcare system. This includes informational events, brochures, and online platforms that inform patients about their rights and options.

What Can Individual Patients Do?

Patients and their families also play an important role in patient safety. Here are some ways they can contribute:

• Get actively involved: Patients should actively participate in their treatment process, ask questions, and ensure they understand all important information regarding diagnoses, treatments, and medications.
• Keep a medication list: It’s helpful to keep an up-to-date list of all medications, including dosages and times to take them, and to bring this list with you to every doctor’s visit.
• Prepare for doctor’s visits: Patients should prepare for doctor’s visits by bringing all important documents, questions, and information about current symptoms or prior treatments.
• Asking safety questions: Patients should not hesitate to ask healthcare staff whether, for example, their identity has been verified or whether hygiene measures are being followed.

Patient safety means more than just numbers and statistics—it represents the trust we place in the hands of our doctors, nurses, and the entire healthcare system. It’s about people who, in their most vulnerable moments, hope to receive the best possible care. Every mistake can change a life forever, but every step forward, every honest conversation, and every learning experience has the potential to protect lives.

If we truly want to improve patient safety, we must take responsibility together, show empathy, and create a culture centered on openness and trust. It is a path that requires courage and commitment, but it also holds hope and the opportunity to emerge from mistakes stronger and better. Because in the end, it is about ensuring that every person can trust, in their darkest hour, that they will be treated safely—and that is precisely the essence of humanity in healthcare.