2nd Victims Support — Training & Resources

sad docRecently, I had dinner with a CMO for a major medical system, and the CMO said it really upsets him when a defense lawyer tells a doc “not to worry about an adverse event or a lawsuit….it will go away…that’s what insurance and lawyers are for.” The CMO said there is absolutely no consideration for the feelings of the doc (or nurse)…no thought about the emotional trauma visited upon the clinician or his/her family. Adverse events are reduced to monetary fights between lawyers.

For 10+years at Sorry Works we have worked to “re-humanize” discussions concerning adverse events….we have continually said that when clinicians/hospitals apologize to patients and families for medical errors, the anger is often removed, and the post-event discussions evolve from an angry fight over money to a more robust and fair discussion of how the financial and emotional needs of the patient/family can be met in an expedited manner, saving everyone time, money, and stress.

Now it is time we worry about meeting the emotional needs of the clinicians involved in adverse events. During a recent trip to California two friendly physicians said until we learn to take better care of clinicians post-event, disclosure will never fully take root. As one doc said to me, it starts with NOT yelling at clinicians post-event and NOT suspending or firing them, and then, as another doc said, giving the doc or nurse and their families the emotional support they need OR it may be impossible for them to say “sorry” to the patient or family.

Our friends at the Center for Patient Safety, based in Missouri, are hosting a 2nd Victim Training Workshop on September 24, 2015 in St. Louis, MO — seats are still available! Sue Scott and Laura Hirschinger of the University of Missouri’s well-known 2nd Victim Support program will lead this training seminar. If you want to learn about 2nd victim support, you need to attend this training seminar.  For more information about this valuable seminar and to register, visit this link.

I dedicated an entire chapter in the new “Sorry Works! Tool Kit Book” to this important issue….be sure to get your copy today. And we hope many people register for the 2nd Victim Workshop offered by the Center for Patient Safety — register by clicking on this link.

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Excerpt from Sorry Works! Tool Kit: Family Wants Chart?

Tool Kit coverIn the new Sorry Works! Tool Kit, we provide a comprehensive review of the most commonly asked questions and challenges you will receive when starting and sustaining a disclosure program. The Q&A section is extremely valuable for c-suite, risk, attorneys, disclosure team leaders, physicians and nursing leaders, etc. Below is one of the questions asked and answered in the Tool Kit — to see the rest be sure to order the new Sorry Works! Tool Kit today.

Q: What do you say if the family asks for the chart?

A: During a disclosure training seminar for a long-term care provider, which included role playing and discussing scenarios, a senior team member played the role of the upset family member and absolutely pelted her colleagues (who were trying to disclose to her) with the following questions and demands:

“Where’s my Dad’s chart? I want to see the chart! When can I see it? I need to see it…RIGHT…..NOW!!”

The senior team member turned to the crowd (her colleagues) and said, “This is the one question we get all the time when trying to talk to an upset family or resident. They want to see the chart, and see it right NOW!” Her colleagues all nodded in agreement.

The same is true in all healthcare settings, including hospitals and physician practices. Families want to know, and know…..RIGHT….NOW!

What do you do?

Of course, there are HIPAA concerns – is this family member actually entitled to the chart? Screw up here and you have a different and expensive problem to deal with. Maybe the patient doesn’t want his crazy uncle from California looking at the chart. Or maybe you are standing toe-to-toe with a “pelican,” that long-lost adult child who hasn’t called dear old mom in twenty years, but now, sensing a financial windfall, the pelican swoops in and if you don’t comply with his every demand, the pelican has threatened to poop on your head. You can’t cave in here, no matter what.

But, if you look like you are stonewalling or hiding the football from a legitimate family member who should have access to the chart – “No, you can’t see the chart…I’m not sure we can give it to you…it would take a while for us to get the chart to you” – you start creating a different problem. Any perception of stonewalling – real or imaginary – will almost always create the impression with family members that you are monkeying with the chart. It will put a cloud of suspicion over everything you say or do downstream, especially if you later report that the event was NOT caused by error. “Sure, they doctored the chart while they were hiding it from us!” will be the retort.

So, what did we discuss during that role play? What did the group say was the best way to handle this tricky situation?

Short answer: Continue to be proactive while following the law.

If the family member can legitimately prove they are entitled to the chart, turn it over as quickly as possible. Don’t play games. Not worth it!

If, however, the family member doesn’t have proof they are entitled to the chart, don’t use phrases that include words like “no” or “you can’t have it” or be off putting in any way. Instead, calmly explain that for the protection of the patient, privacy laws require proof that a family member is entitled to the chart. Show them what documents they need to produce, and, if possible, try to assist them in the process. Be helpful, not defensive. Perhaps provide a small “cheat sheet” to family members that cites a) the law requiring proof (in case they land in a lawyer’s office) and b) what documents are needed to show proof.

If the family member is that “crazy uncle” or “pelican,” the process will protect you and your patient. If, however, the family member is legitimate, the process – if handled in a helpful, proactive fashion – will not be off putting.

Another tip: When a family member demands the chart, gently ask them why they want the chart. A very wise nursing home administrator once told me that doctors and nurses almost always become defensive when the chart is requested, but, sometimes the information sought by the family is very benign or just a simple request. So, before you become defensive or start rattling off HIPPA requirements, just ask why they want the chart in a polite manner. Don’t start an argument or raise suspicions when it’s not necessary.

Just as importantly, try to shift the conversation to things you can do right now with service recovery items such as food, transportation, phone calls, lodging, and other forms of immediate assistance. This shows you care, you are empathetic, and are trying to help as opposed to being an obstacle. Maybe it’s just listening to their problems and acknowledging how upset they are. Keep the conversation going and the relationship alive!

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Recording Surgeries? Surgical Black Boxes?

video taping surgeryInteresting article just appeared in the National Law Review about the possibly of recording surgeries, creating so-called “surgical black boxes” to look for mistakes and mishaps in surgery that might explain adverse events.   The article says researchers at the University of Toronto have developed a black box tool to track surgeries.   Moreover, a Wisconsin lawmaker has introduced legislation that would give patients and families the option of filming their surgeries.  Not surprisingly, the Wisconsin Hospital Association and Wisconsin Medical Society are opposed to the legislation…they are afraid the tapes could be used against physicians in court.

Several years ago I remember talking to a veteran defense lawyer about taping different operations and medical procedures.  This lawyer, who had defended many “bad baby” cases in his career, said it was an absolutely “stupid idea” when OB/GYNs told new dads they could not record the birth of their children.  The lawyer stated that more often times than not the video recordings proved the doctors and nurses did a good job despite the bad outcome.  We threw away a lot of great evidence, said the lawyer.

Remember, the true hallmark of a great disclosure program is telling a patient/family there was a mistake or error even if the family doesn’t suspect something went wrong.  So, in this vein, why be afraid of video taping surgeries and other major medical procedures?   Why should we be afraid of the truth when we are supposed to truthful at all times??

What do you think?   I would like to hear your comments at our blog.

Here is the link for the National Law Review article.

Remember to get your copies of the Sorry Works! Tool Kit Book and Little Book of Empathy.

Sincerely,

– Doug Wojcieszak, Founder, Sorry Works!

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Question from the Road: Patient Calls Complaint Line….After 4 Months?

angry ladyLast month when I was speaking for a major hospital I was asked this question by one of their patient experience staff members.   The woman explained how a patient waited four months after her hospitalization to call and share several serious complaints. She wasn’t sure how to handle the situation.

Answer: Run to the problem!

Patients and families will complain at various times….sometimes immediately after poor service or a potential mistake. Sometimes – like this case – much time will pass while they think about it, get encouragement from friends and family, and/or before they muster the nerve to call. Sometimes they wait to leave the hospital before complaining because they worry griping in the hospital will negatively impact their care.  Other times patients and families don’t complain “directly” but instead speak through a lawyer, a regulator, and/or a member of the media. Heck, it may be a year or two before you hear of a problem, especially if the patient or family is working through a lawyer!

Whenever and however you receive a complaint treat it as an opportunity to make a potentially bad situation right and actually win back a customer. Sometimes the best customers — your most strongest advocates and biggest cheerleaders — are folks wronged by your organization but YOU made it right…including when PI lawyers are involved.

Too often hospitals crawl into their shell when the complaints hit, especially if the family is represented by counsel!  At Sorry Works! we hear and see this all the time where a PI lawyer requests record or makes some other inquiry, and some members of leadership team and front-line staff want to reach out to the patient/family, only to be shut down by legal counsel or the claims guy. It’s wrong….we should always run to the problem, and never be afraid to engage patients, families, and their legal counsel. Find out why they are upset….what the concerns are….and see if the situation can be handled upfront without a protracted legal battle.   Have an adult conversation!   What is the harm in having a conversation?   And when I say “adult conversation” I don’t mean lawyers talking to lawyers…I am suggesting leadership and possibly clinicians (if they are comfortable) speaking to the patient and family.  How often do angry and litigious family members say the doctor abandoned them, never reached out to them, never communicated, etc, etc?   A little talking and a lot of humanity can go a long way!

Note, I’m not asking anyone to prematurely admit fault, be badgered into admissions or fall on their sword, but, instead have a conversation and see what the questions and concerns are. And sure, if necessary bring your attorney and make it clear the conversation is not an impromptu deposition. Express empathy, promise a review with a timeframe, commit to stay connected and follow through, and see if there are any immediate needs that can be addressed. So often litigation ensues because of misunderstandings and missed expectations compounded by the perception of a cover up. And there are plenty of times where legitimate errors are dragged out through a lengthy litigation process because people are scared (or told not to) to have a conversation early on in the process and learn where the finish line is.

Run to the problem and talk!

Hey, 4th of July is in the rear view mirror and back-to-school ads will start soon, which means Fall is right around the corner. Sorry Works! makes a great Grand Rounds presentation for your staff….call 618-559-8168 or e-mail doug@sorryworks.net for more details.

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NICU Staff = Potential Disclosure Champions

NICUA few weeks ago, I gave a series of disclosure presentations for an East Coast hospital, including the hospital’s NICU Department. Speaking before the NICU staff was an interesting and valuable experience. Very quickly it was apparent that the NICU staff already knew or were comfortable with most of the content of my talk. About a third of the way into my presentation, I had to stop and say, “The emotional intelligence of the people in this room is higher than average healthcare professionals…you provide a lot empathy every day for the families you work with….so, this talk will hopefully be a lot of affirmation for you mixed with some new or novel ideas. Also, I encourage you as NICU staff to consider that you could be leaders of the disclosure efforts at this hospital. You could be some of the disclosure champions this hospital needs to develop a successful disclosure program.”

These NICU professionals told me stories and shared experiences of how they work with nervous and sometimes traumatized families. NICU staff understand empathy, they have a lot of practice using empathy, and they appreciate the finer details of helping upset and angry families. Stuff like having a photographer on call when a premature baby dies, etc. Amazing and powerful stuff. Most of the time NICU staff use empathy with deaths which were nobody’s fault, however, when they do have an adverse event they know how to remain connected with families. Empathy is like a reflex for these folks….

In the new Sorry Works! Tool Kit, we talk about the importance of finding your disclosure champions — the people who will lead your disclosure program. Your champions will include the “usual suspects” from risk, claims, legal, and c-suite, but you also need your “hidden champions,” such as staff who have experienced adverse medical events professionally or personally. Add the NICU staff to your list. These folks know empathy, and they have A LOT of practice working with upset and grieving families. They know how to conduct difficult conversations and how to stay connected with traumatized families, and can help other colleagues throughout your organization work through difficult situations.  NICU staff could help make empathy a reflex for the rest of your organization!

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Hospital Apologizes for Death of 19-Year Old Killed By Medical Errors

In 2011, teenager Bronte Doyne’s stomach troubles were diagnosed as a rare form of liver cancer. Surgeons removed part of her liver and thought they had beaten the disease. However, Bronte continued to experience stomach problems and she and her parents reported these concerns, but physicians dismissed the family and told them to stop “Googling” her symptoms. The family continued to journal the situation and ask for help to no avail. By the time doctors listened and re-examined Bronte, it was too late and she died from the cancer a few days later. Very tragic story.

According to media reports (story linked below), the hospital has apologized for their errors, and is working with the family to a produce a video about Bronte’s story that will be shown to staff later in 2015. In a statement, the hospital’s medical director pledged to share the learning from Bronte’s death.

This is all we know at this point…but it’s a lot.

It appears accountability and apology have opened the door to reconciliation and learning with Bronte’s case. We see this time and again in the disclosure movement where apology allows both sides to address the emotional aspects of a case (as well as the financial needs), and a lot of good can be brought out of a tragedy. There are many examples out there of families teaming up with hospitals to share their stories — it’s very powerful stuff. However, without the apology and accountability, family’s typically struggle to let go of their anger, the emotional aspects of the cases are not explored, and situations dissolve into angry fights over money. In other words, if your lawyers and claims guy are worried about money tell them to focus on the emotional aspects of cases! 

We dedicate an entire chapter in the new Sorry Works! Tool Kit Book to inspiring (and maddening) stories of disclosure and non-disclosure. To order, click here. These powerful apology stories will help you and your colleagues conceptualize how apology can work in a medical setting — and provide a lot of motivation too!

To learn more about Bronte’s story, visit this link and this link.

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Defense Lawyers, Claims Guys Just Don’t Get Open Med-Mal Settlements…

Two weeks ago I penned a column about keeping med-mal settlements open (not closed) to encourage learning, sharing of stories, and healing — and to also encourage more transparency and disclosure. See below for original column.

I shared this e-newsletter column through various LinkedIn groups…and some of the defense lawyers and claims guys did not approve. In fact, they were mean and sarcastic.Said I didn’t know what I was talking about….didn’t have any litigation experience or I would know why ALL settlements must remain confidential. One lawyer said we can’t have plaintiffs shouting from the roof tops how much money they got in a case! While another “seasoned” med-mal defense lawyer said he could see no benefit to plaintiffs by making a settlement public, or open.

Wow! We still have a lot of people who just don’t get it! Just don’t understand what these cases truly mean to patients, families, and clinicians. Hint: These cases are not all about $$$.

To be clear, I am not recommending that across the board all settlements should be open. However, we should approach each settlement with the mind-set of keeping it open. Many patients and families want to talk about what happened, and, no, it’s not to scream they “hit the jackpot” but, instead, to describe the care, post-event communications, and what can be done to improve medicine. Clinicians also need to talk about these cases to learn. Everyone needs to talk to heal.

What I am concerned about is when a case is completely closed and we are not allowed to talk about any details: the medical error, the post-event communication (or lack thereof), how the family’s needs were met (financial and otherwise), how the clinicians were treated, how the mistake will be prevented in the future, etc. This is the danger of closed settlements. Disclosure is all about talking and sharing, and the talking and sharing should NOT stop at the settlement.

Finally, talking about a settlement figure is one way to show we are fair to patients and families when mistakes happen. Sure, there will be a few consumers who will wonder, “Gee, where is my payday?” just like there are some defense lawyers who look at new cases and wonder how long they can stretch them out to rack up billable hours.  I choose, however, to look at the positive…focus on the good people who want to do right….people who will look at a fair settlement offer and remark, “The hospital has integrity.”  For too long, the med-mal debate has focused on the negative which has damaged us all.

Once again, some defense lawyers and claims guys have demonstrated their inability to grasp the emotional aspect of med-mal cases. They are so fixated on money that not only do they miss the big picture, they end up costing their employers/clients more money because they continually anger patients and families while emotionally damaging the clinicians they claim to be protecting.

In the new Sorry Works! Tool Kit Book, we dedicate two chapters to the development of your disclosure policy, and open settlements (along with a lot of other great ideas and suggestions) are included in those chapters. Get your copy today!

 

May 20, 2015: Confidential Med-Mal Settlements?

A study was recently released by Dr. Bill Sage, MD/JD on confidentiality agreements in medical malpractice settlements. Sage’s study provides numbers/statistics to a widely known practice in med-mal agreements. However, the summary of the study also says with disclosure becoming more prevalent, hospitals and insurers should re-consider their settlement practices.

I have had several attorneys (both defense and plaintiffs) say that confidentiality agreements are just another “check box” on the way to settlements. It’s simply a habit or common behavior that many people don’t really think about — but needs to be thought about now!

As you design your disclosure program, think about confidentiality clauses in your settlement documents. The whole point of disclosure is to talk about stuff and share stories and experiences…not just with patients and families, but also among clinicians. It’s how we heal and learn. In the new Sorry Works! Tool Kit Book, we say that you should approach all settlements with the mind-set that all cases will remain open for people to talk about (unless there is a really good reason to close a case). The Tool Kit Book (which can be purchased separately or part of the kit) provides a lot of practical advise on how to design, develop, and sustain your disclosure program. For ordering information, click on this link.

Here is the link to Dr. Sage’s study, and here are recent blog postsfrom Sorry Works! on confidentiality agreements, including an article where a hospital required a family to sign a confidentiality agreement before the hospital’s leadership would talk with the family!

 

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2nd Victim Label Angering Some Patients and Families?

Two weeks ago I published an e-newsletter about the need to infuse 2nd victim support into your disclosure program, and mentioned that I dedicated an entire chapter to this concept in the new Sorry Works! Tool Kit Book. Then, I got some pretty harsh blow back from patients and families. Many were outraged that the medical community would consider doctors and nurses to be “victims” of a medical error. One woman wrote — in a nice way — that she could consider clinicians to be “casualties” of an adverse event, but never a victim. Others were not so nice, or rational.

I know words mean things, but I try not to get wrapped around the axle on word choices. For example, within disclosure, there is a push to give a new name to the movement: “CRP.” The C stands for communication, the R for resolution, and P stands for…for….for….I can’t remember what the P signifies. I recently listened to a webinar where an expert tried to explain the difference between CRP and disclosure, and I couldn’t see any difference. CRP is just a marketing term to package disclosure in a different manner (and probably get more consulting gigs!).   I don’t really care. 

OK, so we anger some consumers by labeling clinicians as “2nd victims.” But, what is the real goal of disclosure? To provide transparency and healing for the maximum number of people. It’s never been the goal of disclosure to make everyone happy. There are still plenty of defense lawyers, claims guys, and crusty old docs who don’t like disclosure, but that doesn’t stop us. Same deal with families who are offended with the 2nd victim label. Taking care of clinicians — the 2nd victims — post-event is necessary to make disclosure a reality.  We have to stop yelling at them and suspending or firing them, and, instead, address their emotional needs.  If we don’t take care of the 2nd victims they may not able or willing to disclose to patients and families.

Moreover, in my 10+ years of doing this work, I have come to firmly believe that docs and nurses are truly victimized by deny and defend risk management strategies. Clinicians are involved in tragic, emotionally overwhelming adverse events, but then told to shut up and given no emotional support. Sounds like a victim to me.

Fall is right around the corner…to schedule Sorry Works! for Grand Rounds presentation please call 618-559-8168 or e-mail doug@sorryworks.net.

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Building 2nd Victim Support in Your Disclosure Program

Supporting clinicians or 2nd victims impacted by adverse medical events is a budding field in medicine. In fact, the last two hospitals I helped with implementation of their disclosure programs the medical staff listed support of 2nd victims as their top desire or want from the disclosure program.

There are many disclosure programs out there, and a handful of well-run 2nd victim support programs….but the two ideas — disclosure and 2nd victim support — have not been married together. They need to be, and it shouldn’t be that tough. We’re basically talking about the same skill set for both: Providing empathy, compassion, and on-going support for traumatized people, whether those people are patients and families OR doctors and nurses. Now, there are some nuisances when it comes to taking care of clinicians, but it’s not really rocket science. Don’t yell at doctors and nurses involved in adverse events. Don’t shame or call them names. Tell them you are sorry, be there for them, provide emotional support for clinicians and their families, and keep following up (including professional counseling, if necessary). The same team that helps with disclosure can also assist with 2nd victim support.

In developing the new Sorry Works! Tool Kit Book, I wrote an entire chapter on 2nd victim support programs and how this important concept needs to be hard-wired into your disclosure program. The Tool Kit is a must-have for c-suite, risk, legal, claims, and medical and nursing leaders who are developing or trying to sustain a successful disclosure program. To order your copy of the Tool Kit, just click here.

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Confidential Med-Mal Settlements?

A study was recently released by Dr. Bill Sage, MD/JD on confidentiality agreements in medical malpractice settlements. Sage’s study provides numbers/statistics to a widely known practice in med-mal agreements. However, the summary of the study also says with disclosure becoming more prevalent, hospitals and insurers should re-consider their settlement practices.

I have had several attorneys (both defense and plaintiffs) say that confidentiality agreements are simply another “check box” on the way to settlements. It’s simply a habit or common behavior that many people don’t really think about — but needs to be thought about now!

As you design your disclosure program, think about confidentiality clauses in your settlement documents. The whole point of disclosure is to talk about stuff…not just with patients and families, but also among clinicians. It’s how we heal and learn. In the new Sorry Works! Tool Kit Book, we say that you should approach all settlements with the mind-set that all cases will remain open for people to talk about (unless there is a really good reason to close a case). The Tool Kit Book (which can be purchased separately or part of the kit) provides a lot of practical advise on how to design, develop, and sustain your disclosure program. For ordering information, click on this link.

Here is the link to Dr. Sage’s study, and here are recent blog postsfrom Sorry Works! on confidentiality agreements, including an article where a hospital required a family to sign a confidentiality agreement before the hospital’s leadership would talk with the family!

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