Medical School Dean on Teaching Disclosure & Apology

docThis Tuesday, January 17th, I will have the privilege of being the Keynote Speaker at the Inter-Professional Education & Practice Collaborative at The Ohio State University.   I will be speaking to over 1,000 students and faculty in every health profession school at OSU.  This is the third year I have had the privilege of providing this talk, and, to be frank, I wish I had more of these engagements.  In three to four years these incredibly bright students will scatter around the country (and the world), and take the message of disclosure and apology with them.   Powerful stuff.

We need to do so much more work teaching disclosure and apology to healthcare students — not just medical students but also nursing, dental, vet med, etc.   We should also consider law students and as well as business students who envision a career in the insurance industry.  Get them while they are young.

Two weeks ago I shared the story of a medical student — Mr. Jason Han — who apologized for a medical error by reflecting on a medical error he experienced as a teenager that left him deaf in one ear.  Powerful story.  Well, this week I want to share with you an article written by the Advisory Dean at Jason’s medical school.  It’s an important article from a professional medical educator about the issues we need to consider when teaching students how to confront medical errors, how to communicate with patients and families, and also how to deal with their own emotions. 

Bottom line is it’s not good enough to teach “science” to healthcare students — we must also make them emotionally smart.  

Here is the article from the Medical School Dean, and directly below is the original article about Mr. Han’s apology.

Medical Student Apologizes by Reflecting on Medical Error He Suffered, originally published Jan 4, 2017

Fourth year medical student Jason Han has a unique perspective on medical error and lack of disclosure. As a teenager, Jason and his mom visited his pediatrician for an ear ache. The pediatrician attempted to irrigate Jason’s ear with a large syringe that was too large, and burst Jason’s ear drum, leaving him deaf in that ear. The errant physician assured Jason and his mom that everything was normal, and then refused to return phone calls or any answer inquiries about the incident. Jason said the fact that his physician lied to him and betrayed his family was actually worse than the physical pain.

Fast forward and Jason Han is now a fourth-year medical student at Perelman School of Medicine at the University of Pennsylvania. Recently, a patient suffering from heart failure needed an arterial catheter inserted, and Jason volunteered for the task. Unfortunately, Jason struggled and caused his patient unnecessary pain, and a resident had to complete the procedure. Jason told the Philadelphia Inquirer that he felt ashamed and quickly left the room without saying anything to the patient — but then it dawned on Jason that he was acting no differently than his pediatrician ten years ago. Jason quickly went back to the patient and apologized, and the patient graciously accepted the apology. The article concludes by saying that the Perelman School of Medicine will be teaching disclosure to their medical students, and Jason believes such training would have helped him. Here’s the article.

This story gives me hope as we start the New Year. In my work with medical schools and residency programs, I am hearing more and more young people saying a) they can’t imagine doing any other than disclosure and apology for errors and b) they are shocked that deny and defend was accepted practice for decades. However, we need to train our students…showing them how to disclose and apologize for medical errors needs to be mandatory in the curriculum for all health professionals. Moreover, I have often said that the greatest advocates for disclosure are physicians and nurses who have experienced medical error in their own care (or the care of a family member). Jason Han is one of these important advocates. Finally, we need to provide training to the folks who didn’t learn disclosure in school.

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Really Good Article on How to Avoid Med-Mal Lawsuits..

talkBelow is what I think to be an exceptional article written from a consumer perspective on how to avoid med-mal lawsuits. Now, this article is geared towards long-term care, however, our friends in acute should be able to translate for their environment.

Best,

– Doug

Doug Wojcieszak, Founder, Sorry Works!

Want to prevent lawsuits? Talk to us!

Guest Column

Kitty Foth-Regner

January 02, 2017

Source: McKnight’s

http://www.mcknights.com/guest-columns/want-to-prevent-lawsuits-talk-to-us/article/628282/

I’ve heard a lot of talk lately about suing nursing homes – not only from family members distraught over an elderly loved one’s injury or death in an SNF, but also from the growing chorus of lawyers trolling the local airwaves for potential plaintiffs. “If your loved one shows signs of nursing-home neglect or abuse,” they cry, “you need to consult an attorney right away!”

Certainly, such lawsuits are occasionally warranted. But I wonder how many are instigated by families who’ve been convinced that they have a moral obligation to sue, if only “to make sure it doesn’t ever happen again.”

I have almost 25 years’ experience with a perfectly lovely Wisconsin nursing home, first as the daughter of a longtime resident and, after her death in 2000, as a regular volunteer there. And I’m convinced that a fair share of lawsuits could be avoided if individual facilities, and the industry at large, would do a better job of communicating with key audiences — especially residents’ families.

May I make a few suggestions?

Position yourselves as our partners

From what I’ve witnessed, we all share the same objective: ensuring the elderly of a comfortable, safe, loving and stimulating environment for the rest of their lives.

But don’t count on us family members to remember that a month or two after checking our loved ones into your facility. Prove it to us repeatedly.

For example, does your activities staff go to great lengths to keep residents’ creative juices flowing? Do the folks in dietary bend over backwards to tempt even fussy eaters? Has your PT team had unusual success in getting the wheelchair-bound back on their feet?

In short, continually identify the extraordinary in your facility, and make sure we hear about it.

Tell us what you can do

It never hurts to spell out the advantages you offer residents.

You might begin by reviewing what you tell government inspectors about your capabilities. Could you translate some of it into plain and compelling English to communicate what it means to our loved ones?

For example, how about the number of clinical staff hours each resident receives per day? Do you boast sparkling statistics on minimizing falls or choking events? Do you excel at fast diagnosis and treatment of UTIs? What steps are you taking to further improve the quality of your services?

This is the kind of detail that reminds us how very much you care about everyone in your facility.

Tell us what you can’t do

Believe it or not, some of us assume that you’ll keep our loved ones under 24-hour-a-day observation. Then, when something bad happens beyond our staff’s field of view, we start muttering about neglect, if not outright abuse.

What’s more, we’re likely to blame you for things that are totally out of your control – even when the government has tied your hands. In Wisconsin, for instance, bed rails cannot be provided until a resident has actually fallen out of bed and hurt himself. The reason: it smacks of restraint.

Such restrictions mean that occasional falls are almost inevitable in SNFs. Please discuss such realities of nursing-home life with us, up front and over time. Don’t let our expectations get out of whack. Instead, enlist our help in making sure our loved ones understand their role in staying safe and sound.

Let’s talk money

Many people feel like they’re being ripped off by nursing homes – dangerous thinking when the possibility of a lawsuit crosses our minds.

Why not expose us to the financial nitty gritty before that happens? Show us what private, round-the-clock care would cost in our area. Tell us how much you invest in training your staff and keeping the place spotless. Detail how much you plow back into infrastructure each year. Describe the cost of keeping up with ever-evolving regulations.

Even better: If possible and when appropriate, fill us in on how much of a private-pay resident’s “rent” goes to subsidize those who can’t pay their own way. Most of us are compassionate. And when we realize that our loved ones will continue to receive care even if they run out of money? You’ll see our antagonism melt into gratitude and sympathy.

Tell us how to be heard.

If our loved ones are with you for any length of time, issues will undoubtedly arise. So tell us what to do if we have concerns or complaints. Whose job is it to advocate and intervene for us, and how can we take full advantage of this resource?

Package your messages persuasively

Not everyone will be interested in all this detail. But the more you make available, the happier your residents’ families are likely to be – especially if you carefully craft your messaging and delivery vehicles.

Whichever vehicles you ultimately settle on – brochures or emails, newsletters or videos, social media 0r media relations – effective communications start with meticulous planning and execution. To help ensure the quality and timeliness of your program, do not hesitate to bring in ad agency or freelance professionals up front.

If you can’t afford to do this unilaterally, consider joining hands with other facilities. Or petition your local association to create materials that you and your colleagues can share.

Do it for all our sakes

The immediate goal of such a communications effort may be to stave off litigation. But don’t lose sight of the big picture: If the epidemic of nursing-home lawsuits continues unchecked, will there be any remotely affordable, high-quality nursing homes left 20 or 30 years from now?

I for one hope that the industry will only grow stronger in the years to come. And I’m certain that, launched today, effective communications could help make that a reality for us all.

Kitty Foth-Regner is a retired marketing communications copywriter and the author of Heaven Without Her (Thomas Nelson, 2008). She is currently doing a final edit on The Song of Sadie Sparrow, a novel about three women whose lives become intertwined in a fictional nursing home. Contact her at www.EverlastingPlace.com.

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Medical Student Apologizes by Reflecting on Medical Error He Suffered

jasonFourth year medical student Jason Han has a unique perspective on medical error and lack of disclosure.  As a teenager, Jason and his mom visited his pediatrician for an ear ache.  The pediatrician attempted to irrigate Jason’s ear with a large syringe that was too large, and burst Jason’s ear drum, leaving him deaf in that ear.  The errant physician assured Jason and his mom that everything was normal, and then refused to return phone calls or answer any inquiries about the incident.  Jason said the fact that his physician lied to him and betrayed his family was actually worse than the physical pain.

Fast forward and Jason Han is now a fourth-year medical student at Perelman School of Medicine at the University of Pennsylvania.  Recently, a patient suffering from heart failure needed an arterial catheter inserted, and Jason volunteered for the task.  Unfortunately, Jason struggled and caused his patient unnecessary pain, and a resident had to complete the procedure.  Jason told the Philadelphia Inquirer that he felt ashamed and quickly left the room without saying anything to the patient — but then it dawned on Jason that he was acting no differently than his pediatrician ten years ago.   Jason quickly went back to the patient and apologized, and the patient graciously accepted the apology.  The article concludes by saying that the Perelman School of Medicine will be teaching disclosure to their medical students, and Jason believes such training would have helped him.  Here’s the article.

This story gives me hope as we start the New Year.  In my work with medical schools and residency programs, I am hearing more and more young people saying a) they can’t imagine doing any other than disclosure and apology for errors and b) they are shocked that deny and defend was accepted practice for decades.  However, we need to train our students…showing them how to disclose and apologize for medical errors needs to be mandatory in the curriculum for all health professionals.   Moreover, I have often said that the greatest advocates for disclosure are physicians and nurses who have experienced medical error in their own care (or the care of a family member).  Jason Han is one of these important advocates.  Finally, we need to provide training to the folks who didn’t learn disclosure in school. 

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Not Your Average Holiday E-Mail Wish

treeWe all get them…the holiday email wishes that we delete just as quickly as we throw away season’s greetings cards that are mailed to us. Well, over the last two years I believe I have written some pretty good holiday messages.  Two years ago I encouraged you to put down the smart phones and be more present during the holidays — still a relevant message today! Very relevant. Then, last year, I shared a Christmas Eve sermon on thankfulness I would give as a pastor – also still relevant today.

This year I am writing about the perfect gift to give to family and friends: Listening. We just came through an incredibly bitter campaign which greatly aggravated our tendencies to talk past each other, and over each other. We are so obsessed wanting to show how brilliant we are and get in the last word, that we just don’t listen. We don’t hear why people feel or believe certain things. This is true for not only political opponents, but also spouses, parents, children, co-workers, and seemingly everyone else on the planet. Talk, talk, talk, and more talk…but not enough listening. Bah Humbug, and please shut up for more than five seconds!

Want to give someone the perfect gift…something they will really treasure? Make them feel heard. Try at least once a day to sit down and really listen to one person. Anyone. Your spouse. Your kid. Your co-worker. An old person who is scared and lonely, or a young person bursting with life. Someone who is angry, or maybe somebody who is joyful. Find somebody – anybody! — and just listen. Close your mouth, put away the smartphone, open your ears, and let another soul tell their story. No gift receipt will be necessary.

A very Happy Hanukkah, Merry Christmas, and Happy New Year to all of our friends. See you in 2017!

 

 

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OB-GYNs Support Disclosure…so do PEDS (sorta)

acogEarlier this month, the American College of Obstetricians and Gynecologists, or ACOG, released their formal statement on disclosure, and — wow — I was impressed. What struck me most was the manner in which ACOG asked for hospitals to develop formal disclosure policies and programs, and to provide adequate disclosure training for clinicians. Also, think about, OB-GYNs are high risk specialists…if these folks are endorsing disclosure, what is holding YOU back? Click on this link to read the ACOG statement on disclosure.

The American Academy of Pediatrics also released their disclosure guidelines earlier this month, and, from my perspective, it wasn’t as impressive as the ACOG guidelines. The Peds got too caught up in the legalize and worst-case scenarios (without asking the question, “What could happen to us if we don’t disclose?!”). Moreover, the Peds seem to indicate that legislative help is necessary for disclosure to thrive, when we know that is not the truth. Click on this link to read the Peds’ statement on disclosure.

In conclusion, we will accept both statements as signs of continued progress but also as a reminder of the work that remains to be done. To help Sorry Works! continue our efforts on behalf of disclosure, please make a Year 2016 tax-deductible donation to Sorry Works! by clicking on this link.

 

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Make a Year-End, Tax-Deductible Donation to Sorry Works!

donationsAs you make year-end donations to your favorite charities, we ask that you consider putting Sorry Works! on your list. Sorry Works! recently transitioned to a non-profit organization so that we could broaden our mission, including educating the public (patient/families populations) about the disclosure movement.  Patients and families need to return to their doctors when something goes wrong.  We have developed a white paper explaining our history, the reason for the transition to non-profit status, and our plans for the future — click here for the white paper.

The Year 2017 will be busy for us, and your tax-deductible donation will help us fulfill our mission over the next 12 months. Click on this link to make a donation with your credit card.

You can also write a check payable to “Sorry Works!” and mail to:

Sorry Works!
1063 South State Route 157 Ste 2-111
Edwardsville, IL 62025

We appreciate your consideration, and thank you for your support through the years. Happy Holidays!

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Practice Disclosure Cases for Missed Cancer Diagnoses

confused-look-docTwo weeks ago we published a column concerning a recent survey that showed that 58 percent to 77 percent of physicians would not fully disclose missed cancer diagnoses to patients/families. See below. Our blog post was widely read, and the survey has been covered extensively by the medical/legal trade media.

So, how can staff be trained to handle a potential missed cancer diagnosis? Whether it’s a potential miss within a practice or somehow a diagnosis slipped through the cracks of a hospital or other large system?

Answer: Talk about these cases, and practice!

I remember doing a disclosure training seminar for a large northern hospital system a couple years ago, and one of the cases we practiced with their leaders went something like this….a female patient, who had a Pap smear six months prior that raised concerns with her physician, visits the same physician for an unrelated issue, and during the visit the physician asks the following question: “So, did you follow up with the specialist regarding your Pap smear?”  The patient, dumbfounded, asks, “What specialist? Why would I need to see a specialist? Was something wrong with the Pap smear?!?”

So, now what do you say?

Some clinicians will want to run out of the room at this point.  Others will try to quickly change the subject, or minimize the situation: “Oh, you know, it’s nothing important…er…uh….every so often, we encourage our patients to see a specialist as part of a random, double-check process…you know, random double-check?!  Well, the fact you didn’t go is no big deal…don’t worry about it.  You know, nothing to worry about at all.  Now, let’s get back to the reason for your visit today!”

Liar, liar pants on fire!

However, despite the fact it is easy for the physician to assume that his/her office did not inform the patient about the questionable Pap smear, and, oh my God, cancer may have gone unchecked for six months, etc, there is a possibility the office staff did do everything possible to inform the patient and/or the patient simply did not follow through with the specialist appointment. Patients and families make mistakes too!

In the heat of the moment, you don’t know…so, what do you do?  This is a real struggle for most clinicians and they often run away, lie, or minimize because most have not been trained how to handle such scenarios — but they desperately need this training!

At Sorry Works! we recommend the following for this type of case:

1) Sit down — show good body language

2) Say you are sorry for this alarming situation…”I am sorry this is very alarming and upsetting for you.”  This is empathy, not apology.

3) Show the questionable Pap smear test to the patient, and answer all questions in a truthful fashion, including, “I don’t know, but let me find out and get back to you.”

4) Tell the patient you are going to move Heaven and Earth to get her seen by the specialist ASAP — and then do it.

5) Promise the patient you and your office staff will conduct a thorough review to understand what happened, and you will promise to report back at a specific date/time (no less than a week).

6) Meet the immediate emotional needs of the patient — comfort her, help her make phone calls, make sure she can get home safely, etc.

Make sure the review is conducted in a quick and honest fashion, and report back the findings to the patient, whatever they maybe, including we didn’t get the information to you OR we did provide the information and here’s the proof we did.

In my travels, there was another case where a cancer diagnosis was delayed for four (4) years with fatal consequences because of a system problem in the hospital. The way the physicians and hospital leadership handled this tragic case was amazing — click here to read the story and see the video. This is a great case to share with your colleagues.

 

If you value this content, please consider making a year-end, tax deductible donation to Sorry Works! Simply click on this link to make your donation today. You can also make a check to:

Sorry Works!
1063 South State Route 157 Ste 2-111
Edwardsville, IL 62025

We appreciate your support.

– Doug

Doug Wojcieszak, Founder, Sorry Works!, 618-559-8168

 

originally published November 29 — Survey Shows Majority of Physicians Would Not Disclose Missed Cancer Diagnoses

A recent published survey of 300+ physicians faced with two hypothetical missed or delayed cancer diagnoses revealed that the majority of primary care physicians would not disclose relevant information to patients/families or apologize. Somewhere between 77 percent to 58 percent of the respondent physicians offered little to no information or apology when faced with the scenarios, according to the study funded by the National Cancer Institute.

Now, if we want to be optimistic, we can rightly say that 10+ years ago the same survey would have probably yielded much drearier results — I would guess 90 to 95 percent of physicians prior to the disclosure movement would have offered no information or apology. So, some progress has been made, but the authors of the study, led by researchers at Georgia State University and Kaiser Permanente Georgia, indicated they were expecting better numbers.

Here is a link for a news report on the study.

There were many factors and variables reviewed in the study, and the authors conclude by suggesting that risk, claims, and legal professionals need to understand why so many physicians (and other healthcare professionals) are reluctant to disclose information about potential errors with patients and families.

At Sorry Works!, we have a bunch of anecdotal evidence that explains the numbers seen in this study….our information comes from 11+ years of teaching disclosure and apology to clinicians in the field. Here is our take on what is happening:

1) Not enough clinicians were taught disclosure and apology in school. Some universities are adopting disclosure curriculum, but more work needs to be done in this area. Disclosure, apology and the broader issues or communication, customer service, relationships, etc are timeless issues that every student needs to understand before being turned loose in a clinical setting. Moreover, these topics should be part of required coursework…not optional lectures or elective seminars.

2) Not enough CME/CE programs are teaching (or reinforcing) disclosure principles. We have advocated in the past that disclosure/crisis communication principles should be mandated in the continuing medical education requirements for clinicians. Every doc or nurse will encounter multiple adverse events and angry patients/families in their careers, and clinicians need to understand how to handle these situations — which means training and continual reinforcement.

3) There are not enough formal disclosure and apology programs within hospitals, insurers, and long-term care facilities. Disclosure is a scary topic, and clinicians need support and help…and this means formal programs with workable disclosure policies, the involvement of leadership and staff, and adequate promotion to continually reinforce the disclosure culture.

The bottom line is we have a lot more work to do in the disclosure movement.

 

A good tool to help clinicians understand how to properly address adverse events is the Little Book of Empathy. Priced from $9.99 to $4 per copy, the Little Book of Empathy is an economical and quick read that helps clinicians understand their role in the disclosure process. Click here to order your copies today.

 

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End-of-Year Funds to Spend? We Can Help!

burning-benjaminGot some moolah that is burning a hole in your pocket — literally? Use or lose it by December 31st? That extra cash could help kick-start your efforts to promote disclosure and apology within your organization. Have you always wanted to share material about disclosure and apology with your medical staff, leadership, outside attorneys, etc? Well, use that year-end money and save on the price of some Sorry Works! favorites.

Consider the Little Book of Empathy..this quick read provides the disclosure essentials for all front-line staff in acute and long-term care settings. The Little Book of Empathy shows clinicians how to stay connected with consumers post-event without prematurely admitting fault. The Little Book of Empathy is extremely popular — we have sold thousands of copies of this booklet. Regularly priced at $9.99 per copy, we are providing a special price of $3.49 per copy for the remainder of 2016.

There is also the Sorry Works! Tool Kit…the kit is geared towards c-suite, risk, claims, legal, and medical and nursing leadership, and takes you step-by-step how to launch and sustain a successful disclosure program. The kit includes the Sorry Works! Tool Kit Book and Disclosure Documentary movie and several other items. Regularly priced at $49.99 per copy, the Tool Kit is on sale through year-end for $35.99 per unit.

Click here to order your copies of either the Little Book of Empathy or Tool Kit, or simply respond to this e-mail with the item(s) you want and number of copies. Important: If ordering on-line, the price reduction will be administered when your order is processed.

You can also make a year-end, tax deductible contribution to Sorry Works! by clicking on this link. Your donation will help us expand Sorry Works! mission to include educating the public/patient population about disclosure and apology.

If you have any questions, please contact me directly at 618-559-8168 or doug@sorryworks.net.

 

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White Paper: Sorry Works! Now a Non-Profit Organization

non-profitSorry Works!, the nation’s leading disclosure training & advocacy organization is transitioning to a 501c3 non-profit organization effective December 1, 2016.  There are many reasons for this move, including it will allow us to spend more time educating the public about disclosure while being able to raise funds from foundations, charities, and individuals.  We truly believe educating the public/patient population about disclosure & apology is absolutely critical to advancing our movement.

As you/your organization make decisions about year-end donations, please keep Sorry Works! in mind.  Checks should be made payable to “Sorry Works!” and you can mail your tax-deductible donations to:

Sorry Works!, 1063 South State Route, 157, Suite 2-111, Edwardsville, IL 62025

You can also make a tax deductible donation with your credit card by clicking on this link.    We need funds to get our non-profit operation off the ground.  We have many start-up expenses that need to be covered, including a website update, marketing and spreading the word, insurance policy for our new board, and other expenses.  As you close out the year, please include Sorry Works! in your charitable giving budget.  If you have any questions, I can be reached directly at 618-559-8168 or doug@sorryworks.net.

Immediately below is our initial board of directors, and further below is the complete explanation for Sorry Works’ transition to a 501c3 non-profit organization.

  • Dr. Steve Kraman, MD….Steve and Ginny Hamm, JD, pioneered the nation’s first disclosure program at the Lexington VA hospital.  Steve has been a long-time supporter and friend of Sorry Works, and he and his brother recently developed the Full Disclosure Documentary which is marketed and sold through Sorry Works!
  • Dr. Albert Wu, MD, MPH ….Albert is a Professor of Health Policy and Management at the Johns Hopkins School of Public Health. A leading expert on disclosure and the psychological impact of medical errors on both patients and caregivers, he may be best known for coining the term “second victim” in a 2000 British Medical Journal article.
  • Wade Westhoff, CFP, AIF….Wade lost his daughter to medical errors in a Oakland hospital.  Wade and his family have shared their story extensively through Sorry Works, and their journey has taught countless clinicians and leaders how to behave in a more humane and ethical fashion post-event.
  • Ravi Narayan, CSP, ARM, CPASRM…Ravi is a risk manager for John Knox Village, a large assisted living and long-term care provider near Kansas City, MO.  Ravi and his team have worked with Sorry Works! to implement disclosure and apology with their clinicians and staff.
  • Todd Bartos, JD… Todd R. Bartos, J.D., is a veteran healthcare attorney with subspecialty expertise in risk management, patient safety and healthcare technology. Todd has a national reputation and is an invited speaker on healthcare issues for hospitals, integrated medical groups and clinical and systemic risk issues.  Todd teaches physicians, hospital administrators and healthcare attorneys in all areas of healthcare law, including risk mitigation, litigation, crisis communication, implications of regulatory changes and the impact of the ACA and related regulations on the business of healthcare.  He has recently published the Professional Liability and Risk Mitigation chapter in the AHLA Representing Physicians Handbook (4th ed.).  In his 18-year career, Todd has taught more than 25,000 physicians and dozens of hospital administrators in all areas of clinical risk management and disclosure and has overseen and litigated more than 400 claims. In addition to his private practice, Todd serves as General Counsel for Aspire Ventures, a venture capital firm in Lancaster, PA, where he has a broad practice spanning healthcare, corporate, transactional, regulatory, government affairs, compliance, employment and IP law.  He also consults with leading healthcare organizations and startups regarding legal issues and business strategy.
  • Linda Snell, DNS, RN….Linda is a nurse educator at the College of Brockport with over 25 years of clinical experience.  Linda also experienced a crippling medical error that was covered up and never acknowledged.
  • Dr. Bob Israel, MD…. Bob is a Professor of Obstetrics and Gynecology at the Keck School of Medicine at USC where he is the director of the women’s health clinics and chair of quality improvement, LAC+USC Medical Center. He is a strong proponent of disclosure and 2nd victim support and has worked hard to advance disclosure principles with his residents/faculty and across the LAC+USC Medical Center in general.
  • Dr. Peter Schwartrz, MD…Peter has taught countless disclosure training seminars with Sorry Works!, and he was one of eight physicians recently elected to American Medical Association’s Council on Ethics and Judicial Affairs.
  • Lee McMullin, CPHRM….Lee is a seasoned risk manager and strong disclosure supporter who is the immediate past-President of the Southern California Association for Healthcare Risk Management (SCAHRM).
  • Dr. Robert Cisneros, PhD…Bob is an Associate Professor of Pharmacy at Campbell University.  Bob has clinical experience with the value of disclosure and apology, and he teaches disclosure principles to his pharmacy students.
  • Doug Wojcieszak….Doug is the Founder of Sorry Works! and taught disclosure to thousands of healthcare, insurance, and legal professionals over the last 11 years.
  • Bob Kellogg…Bob has enjoyed a long career in the medical malpractice insurance industry and is a strong supporter of disclosure and apology.  Bob is currently the President/CEO of Mesa Medical Insurance, and his prior positions included COO of New Mexico Mutual and President/CEO of State Mutual Insurance Company (Michigan).

Special advisor to the board:

Dale Micalizzi….Dale lost her child, Justin, to medical errors and the hospital never disclosed or apologized.  Dale has used her grief to become a true dynamo in the patient safety world.  She has shared her story through Sorry Works, and is a powerful national advocate for disclosure and patient safety.

 

Executive Summary

Sorry Works, the nation’s leading disclosure training and advocacy organization, seeks to transform from a for-profit LLC business model to a 501c3 non-profit organization.   It is believed that this transformation will open new revenue sources for Sorry Works! (foundations, charities, individual donors) and allow Sorry Works! to focus on non-revenue generating work such as 1) educating the public about disclosure; 2) more aggressive media and social media work to educate stakeholders about disclosure; 3) generating reports and research projects; 4) advocacy work for legislation and regulatory reform that promotes and supports disclosure; 5) uncompensated presentations and staffing booths at conferences to further engage stakeholders; and 6) giving away content to certain organizations while still being able to service Sorry Works’ historical revenue generating work of paid speeches and selling books, booklets, and other content.

 

History

Sorry Works! was created in 2005 by myself, Doug Wojciezak, as a “pro-bono”  project through a small public relations firm I owned at the time.  The original goal of Sorry Works! was to be a vehicle through which the story of disclosure and apology, originally pioneered at the Lexington VA hospital by Dr. Steve Kraman and Ginny Hamm, JD, could be shared with hospitals and insurance companies throughout the United States.  We wanted Sorry Works! to show all the stakeholders (doctors, patients, lawyers, insurers, etc) that there was a more humane and economical way to address medical errors (versus the traditional deny and defend risk management strategies).

Dr. Kraman and a few others agreed to be an informal board of directors for Sorry Works!, and the group was officially launched in February 2005 with a well-attended audio press conference that garnered several news stories, including a large piece in the American Medical Association newspaper.   From there, I created the first Sorry Works! website and started distributing an e-newsletter with disclosure stories/issues every one to two weeks.  The original e-mail distribution list was 50 or so e-mails addresses of friends and interested news reporters.

Sorry Works! quickly caught fire over the next year.  The media (both popular and trade publications) continued to be fascinated with the novel and cost-saving approach to medical malpractice advocated by Sorry Works!  Stories appeared in numerous publications, including Time Magazine, and countless medical, insurance, and law industry trade publications.  The e-mail distribution list for the e-newsletters grew steadily with every media story, and I also started receiving request for speaking engagements.

By late 2006, the “pro bono” Sorry Works! project which initially took less than five hours per week, quickly grew to 20 to 30 hours of my time per week.  While the success was heartening, the workload for Sorry Works! was crowding out my compensated work and something had to be done.  I enjoyed doing Sorry Works! and the attention garnered by Sorry Works! was truly thrilling, but with a wife and a baby at the time (who is now 10 years old!), I couldn’t keep doing Sorry Works! for free.

So, I had a choice to make: Incorporate Sorry Works!  as a non-profit and hope to raise funds to support it, or turn Sorry Works! into a for-profit limited liability corporation (LLC) and use paid speaking engagements and sales of content to support my work for Sorry Works!  I voted against the non-profit route in late 2006 for the following reasons:

  1. Despite the early success, Sorry Works! was relativity unknown in late 2006, and I believed it could easily be overlooked or dismissed by potential funders.
  2. I was relatively unknown, especially in healthcare, and I did not have a formal healthcare background. At that time, there was a real bias against patient/family involvement in patient safety.  Moreover, within the risk management community, the prevailing thought was that only lawyers or doctors could teach doctors how to say “sorry.”   During 2005 and 2006 I was often told, “Well, you’re not a lawyer or doctor, so, there is nothing YOU can teach our medical staff!”  I am not kidding.
  3. Disclosure was a very controversial topic in 2006, and taboo in many quarters.  I thought many potential funders would shy away from a group dedicated to advancing disclosure and apology.
  4. I did not want to spend all of my time writing grant applications and begging for money…instead, I wanted to use my time creating and selling content to teach healthcare professionals how to communicate with patients and families after something goes wrong.

So, I chose the for-profit LLC status for Sorry Works!  Despite the controversy surrounding disclosure and apology in 2006/2007, there was a real appetite in the market place for content about disclosure, including speeches and books.  And the hunger for this information was so great that people were willing to overlook the fact that Sorry Works! and me were unknowns. Sorry Works! became an Illinois limited liability corporation in 2007, and began selling lots of content.

Over the last nine years (2007 through 2016), I have authored two books (Sorry Works! 2.0 and the Sorry Works! Tool Kit Book) and one booklet (The Little Book of Empathy) through Sorry Works! and have sold over 35,000 copies of these publications. Sorry Works! 2.0 has been translated into Korean and Japanese, and the Little Book of Empathy was translated into Japanese.  The publication of these books/booklets led to hundreds of compensated speeches and training engagements in 43 different states for acute and long-term healthcare organizations, as well as Canada, Australia, and Poland. Sorry Works! has a national and international following.  I have also given dozens of webinars to thousands of healthcare, insurance, and legal professionals over the last nine years.  Sorry Works! has developed on-line disclosure training content with The Sullivan Group, and we have partnered with Steve and Larry Kraman in the marketing and sales of the “Full Disclosure” Documentary.  The Sorry Works! website is viewed by nearly 500 unique visitors per day, and the Sorry Works e-newsletters list has nearly 2,000 subscribers.  Sorry Works! also has a strong and growing presence in social media (Facebook, Twitter, LinkedIn).   And, through the years I have also conducted countless media interviews with popular and trade publications.

Not only has the revenue from book sales and speaking/training engagements provided me the chance to work for Sorry Works!, but it has allowed Sorry Works! to be a large, visible force for the disclosure movement.  I can say without bragging that Sorry Works! has had a major hand in propelling the disclosure movement forward.  Sorry Works! has raised much awareness about disclosure and apology, and Sorry Works! training seminars and content have taught disclosure techniques and principles to tens of thousands of healthcare, insurance, and legal professionals around the country.  Sorry Works! is literally the brand name of the disclosure movement.

By generating revenue in a for-profit model, Sorry Works! has a proud record of advancing the disclosure movement, but there is more work to do.  We need to educate the public and the trial bar about disclosure…we must share best disclosure practices (and also share failures) across the country…and we will need to continue training front-line clinicians, as well as leaders, in acute and long-term care organizations.

 

Need to Transform Sorry Works! into 501c3 Non Profit Organization

I have noticed a decline in book sales and also speaking engagements over the last two years.   There are only so many books that one can sell about a particular topic, and there is a lot more competition out there.  This is especially true with speaking and training engagements, as large risk management consulting groups are marketing themselves for disclosure training to hospitals and long-term care organizations.

I believe the time has arrived to revisit the issue of LLC vs. non-profit for Sorry Works!, and I  am now advocating that Sorry Works! become a 501c3 non-profit organization.   In short, the problems that we would have encountered making Sorry Works! a non-profit in 2006/2007 are no longer present (or are significantly diminished).  Becoming a 501c3 route would allow Sorry Works! to a) pursue revenue from new sources (foundations, charities, non-profits, individual donors, etc) and b) spend more time on non-revenue generating work that advances the disclosure movement. Sorry Works! and myself are very well-known in healthcare, insurance, and legal circles, and we have an impressive track record.  Moreover, patients and families are now welcome partners in improving patient safety, and I have personally taught disclosure techniques and principles to thousands of clinicians as well as insurance and legal professionals.   Disclosure is no longer controversial, but much work remains to be done, and Sorry Works! will be uniquely positioned as a non-profit to fill many different roles in the disclosure movement.   Indeed, Sorry Works! would have a more favorable chance pursuing non-profit funding in 2016 (versus 10 years ago).

However, as a non-profit, Sorry Works! can continue to fulfill its revenue generating activities (speeches, training seminars, book sales, etc).  There is nothing unethical or illegal about a non-profit selling their services or content — non-profit hospitals do it every day!

 

New Sources of Revenue for Non-Profit Sorry Works!

A foundation, charity, or individual donor will probably never hire Sorry Works! to give a compensated speech or even purchase a book from us, but, if these organizations or individuals see value in our work/mission they can make tax-deductible donations to us (since Sorry Works! will become a 501c3).  I believe there are many organizations and people that will make large and small donations to Sorry Works! once we have a 501c3 status.  

 

Non-revenue generating activities for Sorry Works! that Will Support the Disclosure Movement:

With donations, Sorry Works! can pursue activities other than paid speeches or selling books.   Here are some topics/areas we can focus on as a non-profit:

  • Educate the public about disclosure through the media, social media, and by partnering with special interests group like AARP and others. The public does not know much about disclosure and apology, and they don’t know what to expect from clinicians post-event or how to engage their doctor/hospital after something goes wrong.  We can help here – significantly.   Sorry Works! has unique attributes and qualities that suit it to lead education efforts with the public and also the trial bar.
  • Continue to educate med-mal stakeholders with more aggressive media and social media work (more aggressive than we have been able to do as an LLC).
  • Generate reports and research projects concerning topics of interest to the disclosure movement.
  • Advocacy work for legislation and regulatory reform that supports and promotes disclosure (this would NOT include supporting candidates, which is prohibited for 501c3 organizations).  We could help more states follow lead of Massachusetts and Oregon.
  • Use some donations to provide “unpaid” speeches and staff booths at industry conferences and events.   Do more physical outreach with stakeholders.
  • Give away content to organizations and individuals that have tight or restricted budgets.
  • Continue training front-line clinicians and leadership in acute and long-term care health organizations as well as claims, risk, and legal professionals.

 

Sorry Works’ Unique Attributes That Position it to Serve the Disclosure Movement:

  1. Sorry Works! Founder Doug Wojcieszak has experienced medical errors twice in his family, and Wojcieszak has trained thousands of healthcare, insurance, and legal professionals on disclosure techniques and principles.   Wojcieszak is also a PR professional by training.  Sorry Works! is uniquely positioned to serve the disclosure movement, especially with educating the public.
  2. Sorry Works! doesn’t pull punches – we are not owned by a healthcare consulting company or insurer worried about “relationships” with clients or potential clients.   Nor are we wedded to any patient safety advocacy groups.  We call them like we see them.  Sorry Works! is a clear, unencumbered voice for the disclosure movement, which is so important when discussing transparency!
  3. Sorry Works! is the brand of the disclosure movement, and very well-known in healthcare, insurance, and legal circles.  We have a large following.
  4. Sorry Works! is the only national organization dedicated solely to disclosure and apology.  It’s what we do 24/7.
  5. Sorry Works! is the only national disclosure training organization with an active website that attracts nearly 500 visitors per day, regular e-newsletters, and vibrant social media presence.
  6. Sorry Works! is a long-standing, reputable source for popular and trade media outlets.  Reporters know us.
  7. We have a virtual library of content about disclosure that will continue to be upgraded and updated.

Next Steps

We will be updating our website and completing other tasks associated with our transition to a non-profit organization.   We hope to have the majority of these tasks completed in the next six weeks.  By the end of the first quarter of 2017, we will begin our efforts to educate the public/patient population about disclosure and apology by focusing on a handful of test markets.   We will also start engaging grant writers and exploring different sourcess for funding.  More details to follow.

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Survey Shows Majority of Physicians Would Not Disclose Missed Cancer Diagnoses

hidingA recent published survey of 300+ physicians faced with two hypothetical missed or delayed cancer diagnoses revealed that the majority of primary care physicians would not disclose relevant information to patients/families or apologize. Somewhere between 77 percent to 58 percent of the respondent physicians offered little to no information or apology when faced with the scenarios, according to the study funded by the National Cancer Institute.

Now, if we want to be optimistic, we can rightly say that 10+ years ago the same survey would have probably yielded much drearier results — I would guess 90 to 95 percent of physicians prior to the disclosure movement would have offered no information or apology. So, some progress has been made, but the authors of the study, led by researchers at Georgia State University and Kaiser Permanente Georgia, indicated they were expecting better numbers.

Here is a link for a news report on the study.

There were many factors and variables reviewed in the study, and the authors conclude by suggesting that risk, claims, and legal professionals need to understand why so many physicians (and other healthcare professionals) are reluctant to disclose information about potential errors with patients and families.

At Sorry Works!, we have a bunch of anecdotal evidence that explains the numbers seen in this study….our information comes from 11+ years of teaching disclosure and apology to clinicians in the field. Here is our take on what is happening:

1) Not enough clinicians were taught disclosure and apology in school. Some universities are adopting disclosure curriculum, but more work needs to be done in this area. Disclosure, apology and the broader issues or communication, customer service, relationships, etc are timeless issues that every student needs to understand before being turned loose in a clinical setting. Moreover, these topics should be part of required coursework…not optional lectures or elective seminars.

2) Not enough CME/CE programs are teaching (or reinforcing) disclosure principles. We have advocated in the past that disclosure/crisis communication principles should be mandated in the continuing medical education requirements for clinicians. Every doc or nurse will encounter multiple adverse events and angry patients/families in their careers, and clinicians need to understand how to handle these situations — which means training and continual reinforcement.

3) There are not enough formal disclosure and apology programs within hospitals, insurers, and long-term care facilities. Disclosure is a scary topic, and clinicians need support and help…and this means formal programs with workable disclosure policies, the involvement of leadership and staff, and adequate promotion to continually reinforce the disclosure culture.

The bottom line is we have a lot more work to do in the disclosure movement.

 

A good tool to help clinicians understand how to properly address adverse events is the Little Book of Empathy. Priced from $9.99 to $4 per copy, the Little Book of Empathy is an economical and quick read that helps clinicians understand their role in the disclosure process. Click here to order your copies today.

 

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