Ann Marie Swindler – Bayhealth Medical Center
Healthcare professionals, especially nurses, saw a sharp uptick in violence during the COVID-19 pandemic. According to the American Hospital Association, studies have found that up to 44 percent of nurses withstood physical violence and 68 percent dealt with verbal abuse from patients during the pandemic.
Those trends surfaced at Bayhealth Medical Center in Dover, Delaware, where Associate General Counsel Ann Marie Swindler found herself comparing notes with nursing, medical and public safety staff on how best to combat the rising temperature in clinical settings.
Bayhealth’s risk and legal teams implemented measures to safeguard caregivers, including working with public safety to respond to violent incidents and proactively identifying patients or visitors who presented a heightened risk. They also developed a zero-tolerance policy around abuse and encouraged a culture change that required staffers to sublimate their compassion to self-preservation. Today, Bayhealth’s care setting is safer for everyone as a result.
“My favorite part of my job is that I get to work with and support the heroes who take care of the patients,” Swindler says.
Creating a captive insurance subsidiary
Much of Swindler’s day-to-day work centers around risk management. And one of the initiatives she’s proudest of is the development of a captive insurance program at Bayhealth, which launched in April 2023.
That required setting up a subsidiary company that exists to insure the parent company. The customers for the captive are Bayhealth employees; it manages professional liability for the entire organization.
Whereas a traditional insurance program requires paying a premium to an insurer, which customers never see again, a captive works more like a medical savings account. If Bayhealth can minimize the cost of claims related to those premiums, it can reinvest them in its hospital, providing new equipment or additional staff.
“When we can leverage our risk management process so that our claims and losses are reduced, we can keep more of our resources,” Swindler says. “It also creates more buy-in for risk management. So, it matters that much more to a nurse on the floor whether he or she is being mindful of risk management because it might mean being able to fund additional staff or equipment for his or her unit.”
A multi-front educational push
On July 1, Swindler will launch a related educational initiative targeting Bayhealth’s clinical staff. She wants to advance a “more proactive” risk management program in concert with the rollout of the captive.
This involves giving clinicians an overview of risk management—the role it plays in the hospital and in external practice, and why it’s important. There will also be individualized education on litigation avoidance, plus practice-specific education for areas like emergency care, surgery and OB-GYN services.
“Doctors and nurses in different areas of specialization have different stressors and different obstacles or opportunities than others,” Swindler says. “There are particular things we can do to prevent errors and misunderstandings that lead to claims.”
Swindler has also been working to educate residents on risk management since Bayhealth welcomed its first class two years ago. Medical school students often don’t learn risk management, she notes, and as a result may begin practice unaware there are lawyers and risk managers in hospitals to whom they can reach out.
“Residency is a great place to reach them,” she says. “If we can ingrain that risk management mindset in them early, it’s very helpful.”
Swindler works with residents by doing outreach to the graduate medical education department, making sure they know who she and her colleagues are. She and her team also orient new practitioners coming into the hospital.
Swindler has further set up a risk management hotline at Bayhealth for care providers to call.
“Right now, I’m the only one who mans the hotline, so it’s a 24/7 job for me,” she says. “But we’re bringing more people into the department, so we’ll be able to have a little bit of a rotation soon.”
Finally, Swindler’s department serves as the keeper of all the data in the adverse event reporting system. They use that data to act on specific reports or to aggregate all the reports to inform choices about where to target future education.
Learning guiding principles
A graduate of Old Dominion University, where she received her B.S. in registered nursing, and the University of Georgia, where she earned her J.D. in 2005, Swindler also attained an LL.M. in health law from Loyola University Chicago in 2014.
“I actually never intended to be a nurse,” Swindler says of her first career, adding that law remained at the back of her mind. “I got married at 18, and I married someone in the Navy, and thought, ‘I’d better get a job where I can always find employment wherever we land.’”
But once she tried nursing, she fell in love with it. In the late nineties, she worked at St. Mary’s Nursing Center, at Calvert Memorial Hospital and at St. Joseph’s/Candler Health System. In 2002, while in law school, she worked at St. Mary’s in Athens, Georgia, with newborns in perinatal care.
In 2005, Swindler tackled her first legal role as associate general counsel at MCG Health. She moved to the Billings Clinic in 2008, and CaroMont Health in 2010. In 2013, she joined Carilion Clinic as vice president of risk management, and in 2016, she joined Memorial Health, staying three years before moving to Bayhealth.
Swindler credits her first associate general counsel, Judy Cline, and a physician in Savannah, Raymond Meguiar, with teaching her the importance of transparency and integrity, and when in doubt, to always favor the best interests of the patients and care teams.
“If you’re doing what’s best for the patient and those who are providing him or her with care, you’re always going to be okay,” she says. “And that has guided everything I’ve done.”
View this feature in the Vanguard Summer II 2023 Edition here.
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