There are no geographical limits when it comes to medical professional liability (MPL) industry challenges, as the members of the International Section of the MPL Association can attest. Through mid-2023, the International Section consists of 12 member companies spread across the United Kingdom, Australia, Canada, the Netherlands, and France.
These individual companies are quite diverse—some are insurers, others are defense organizations and still others operate with government links or backing, according to Dr. Matthew Lee, CEO of the Medical Defence Union in the United Kingdom. Their scale varies, with some covering millions of healthcare professionals, while others operate at more modest levels. While some are country-specific, others operate across geographic boundaries. Lee has been the chair of the MPL Association’s International Section since 2021.
“The International Section brings a real global perspective to the Association,” Lee said. “That’s not just in terms of geographic environments, also different legal environments with different business models. Discretionary mutuals that you find in the UK and Canada, for example, are fundamentally different than anything you find in the United States in the way they operate, the way they are taxed, and how they fund their litigation, as well as the services and benefits they provide.”
When Lee visits member companies, which he has done throughout the world, there is one constant: What can we learn from each other? There are a lot of things that international companies can learn from American companies, and, likewise, many things that American companies can learn from international companies. “This is where the different business models offer advantages,” Lee said. “If there is a business problem facing companies in the US market, there are quite possibly companies in the international section that have seen the same in their country and already developed a solution.”
In this Q&A, Lee discussed the benefits of cross-border and cross-cultural learning and development.
IML: How can all MPL Association member companies benefit from our collective knowledge, both in the US and internationally?
Lee: If there’s a business problem in one area of the MPL industry, it is very likely that someone in another area of the industry has experience and can offer perspective. Here’s a nice example: In the UK, when we were preparing to leave the European Union, we suddenly had a lot of questions about healthcare across borders. We were able to benefit from the American MPL Association members, who deal with cross-border issues across state lines all the time. Then, when COVID hit, there were many questions from US insurers about telemedicine and there was some experience within the international community about the legality of telemedicine across borders, between countries, and across continents.
IML: What commonalities do you find between the US MPL industry and the international MPL industry?
Lee: Essentially, the US MPL companies, and the International MPL members are doing much the same thing. They are protecting doctors, healthcare providers, and other health professionals from litigation and other challenges that those individuals face. There are also many similar issues facing companies globally. You get global issues like pandemics, a situation where we saw much ongoing dialogue between the medical directors of the US MPL companies and the medical directors of the international companies. We also witnessed quite a bit of conversation between international member companies, which are, in some cases, the only company doing what they do in their country, seeking insight as to what was happening in other countries.
IML: What other issues are common across international borders?
Lee: One issue is claims inflation. Claims inflation tends to be cyclical and the cycles don’t always correlate. You’re seeing a hard market in the US and we’re seeing a soft market in the UK. So we can look at the US, and consider whether a harder market will be coming to the UK. Or maybe companies in the US are wondering if their market will soften. Frequently, there are interesting indicators to look at elsewhere in the world as to trending issues.
Another common issue is changes in healthcare all around the world. If you speak to internal members, you’ll hear about challenges with medical resourcing such as an insufficient number of doctors and healthcare providers. There’s a universal struggle to get enough people on the ground to provide healthcare. That leads to considering alternative methods to providing that care.
IML: What kind of alternatives are you seeing?
Lee: One alternative is placing a greater reliance on technology, which in itself introduces new risks, another, advancing the skills of other professionals who traditionally wouldn't have undertaken those types of care. And looking at other countries you can see things that have been tried in other countries that have worked and you can see things in other countries that haven't worked. The US, for example, was quite ahead of the game in terms of para healthcare professionals like nurse anaesthetists. And we're now seeing that appearing in Europe. It’s been beneficial to view an established model for how that works somewhere else. If it’s going to evolve in another country, then examples around the world can help steer that innovation.
IML: What else are you seeing?
Lee: Telemedicine is another interesting case because elsewhere in the world, telemedicine was pretty well established, where as it was quite new in the US during COVID. In other countries, doctors and healthcare professionals have been providing full healthcare remotely using telemedicine for quite some time. If something is new in one country, the chances are somewhere else in the world it's being done. But broadly, there are similar issues.
There are huge parallels between what all the companies are doing, but if anyone is facing something that's evolving, then often they're looking internationally at how it's evolved. Half the countries internationally will be behind. Half the companies will be in front on any one issue and you can find people who are two years further down the road if you look hard enough, and see how things are likely to turn out.
IML: From your perspective, why is it important for MPL companies across the world to collaborate through the MPL Association?
Lee: I think as an industry, there's a lot that can be done if the companies work together on certain issues. Clearly, individually companies have to consider competitive issues—particularly if participating in discussions with competitors at the table. With international section meetings, we often have two of our competitors there but potentially we also have nine other companies that don't compete against us. So, actually, there's a pool of people that enable you to have discussions on topics and enable you to work together effectively, and similarly with the US and outside the US.
Fundamentally, a big part of the management of medical liability claims is managing the clinical risks that are inherent within the healthcare provision. And that might be through education. That might be through direct intervention. That might be through actually being part of the system yourselves. And I know a number of the MPL companies are actually part of healthcare provider organizations. At heart, trying to manage litigation risk is not quite the same as trying to manage clinical risk, but they're certainly very well aligned. While some of the international member organizations have a specific purpose to try to improve patient safety or reduce medical risk, we all end up doing it anyway because good insureds or members want to manage their risk and bring down litigation risk by improving patient safety.
IML: What are some examples of collaboration taking place now?
Lee: Many of us are already participating in initiatives that share data and subject specific experience, which enable healthcare providers to provide safer healthcare that benefits the whole industry. We do that at meetings, like the conference we just had in New Orleans. And we do that in individual sections. I know that the 12 companies in the international section get together regularly virtually, and that is something that we could definitely replicate more broadly.
We’ve also established some information sharing hubs that are quite useful. The first one was around telemedicine, with members collating useful articles that describe the position and developments in their country. It’s interesting to see how the issues evolve differently in different countries. We’re looking at other subjects to build up more hubs. We’ve also set up some specific networks for individuals in specific areas, such as government relations.
IML: That’s interesting. How do you see that evolving?
Lee: We’ve just established a network for the information technology/chief information officers and chief information security officers. They had a session recently examining cybersecurity where they were able to share best practice at a more operational level. These are areas where it is very useful to have a network of peers who you can talk to or even visit.
We've had members of our staff go out and visit other international member companies. So, for us, it provides great networking opportunities for our staff. And, from our perspective, the US members are just as “international” as our section members, so we’d be open to having them join us in some of our endeavours.
IML: How do MPL Association meetings tie into all of this?
Lee: Yes, obviously meetings and conferences are a big part of this. Every three years, the International Section runs an International Risk Management Seminar, which this year is in Pittsburgh at the Kimpton Hotel Monaco on Sept. 20. This year’s meeting focuses on patient safety, specifically systemic safety and resilience in healthcare. We’re excited about the speakers, which include member companies from the UK, Canada, the Netherlands, and Australia. The next full international conference is scheduled to be in Australia in 2025.
IML: What does the future hold for the MPL Association and international collaboration?
Lee: I think the obvious trends that keep coming up in discussions are around technology. They're around how healthcare will be provided in the future and how technology will support that and what risks technology might provide. Increasingly, people are talking about more advanced AI, and what role it has in healthcare, whether it's in diagnostics, whether it's in patient support.
There is also an unfortunate trend of the criminalization of medical errors around the world. That is something that we see more of in Europe, and particularly the UK. And as seen in the US, we've had a number of significant criminal investigations.
IML: What is your experience with this in the UK?
Lee: We've had doctors who've been our members and members of other organizations here in the UK go to prison on the back of medical errors. And if you talk to some of the international members, they're seeing increasingly, across the world, that criminal prosecution of individuals for medical errors is becoming increasingly common, which opens up a whole new set of questions about what legal expenses in a policy needs to include and the type of expertise that’s required to support these individuals.
IML: How does your organization support them, given your increased exposure to this type of risk?
Lee: We offer a robust legal defense—we have our own specialist criminal legal team—and a model that involves our doctors on the staff providing 24-hour support. That means any of our members who find themselves detained or arrested in connection with a medical error will be able to speak to a doctor any time. We’ve found that this model of personalized, physician-to-physician support quite valuable in these situations and many others.
IML: Thanks so much for your time, Matt!
Lee: You’re very welcome.