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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Sorry Works! Tool Kit Now Available!

Today we are launching the Sorry Works! Tool Kit. The tool kit has everything that a hospital, long-term care organization, large practice group, or insurer needs to develop and sustain a successful disclosure program.

Included is the new Sorry Works! Tool Kit Book, which literally provides a blue print for starting a disclosure program. This new book has step-by-step instructions on how to build your disclosure team, develop your policy, and launch your disclosure program and keep it alive. The book has lots of practical advice, lessons from around the country, cases and stories, and practice cases for you and your team to role play. Also included in the Tool Kit are the Patient/Family Education Document, Sorry Works! PPT slides for front-line staff, and copies of the Little Book of Empathy and Pocket Notes. It’s a very comprehensive tool kit developed for c-suite, risk, claims, legal, and medical and nursing leadership. At $37.99 per copy, the Tool Kit is very affordable…you can pay with credit card or be invoiced by clicking on this link.

You can also purchase individual copies of the Tool Kit Book, Little Book of Empathy, and Pocket Notes by clicking on this link.

Finally, bulk pricing is available for large orders…simply contact 618-559-8168 or doug@sorryworks.net for more information.

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Medical Errors Hidden from American Soldiers — task for Obama??

At age 44, I am not old enough to remember the Vietnam War. However, I do remember that during the 80’s the American public awoke to the fact that the troops were treated in a shabby fashion during the war. As a grade school student, I remember when the Vietnam Memorial was unveiled in Washington DC, and that it was not only a monument honoring the sacrifice of our solders, but it was also – in a way – an apology to the troops and their families.  When the Wall was dedicated, I remember hearing stories of how soldiers coming home from Vietnam were protested, ridiculed, and, sadly, in some cases spit on. Too many veterans said things like, “We weren’t very popular when we came home” or “We were embarrassed to wear our uniforms in public” or “The protesters called us ‘baby killers’ and spit on us.”

We don’t have this problem anymore. Even during the controversial Iraq War, American troops and their families rightly enjoyed strong public support. Our troops receive the very best our country can give — except when it comes to medical errors in military hospitals. We’re still spitting on our troops.

The New York Times recently published a lengthy article – see link below – about how active duty service members who experience adverse events in military hospitals cannot receive explanations, answers, or even an apology. Soldiers and their families are driven crazy, says the Times article. Our warriors get the silent treatment. The article contrasts the military’s approach with the small but growing number of public/civilian hospitals embracing disclosure and apology. One of the excuses given by the military for not talking is that doing so might encourage lawsuits by civilians who receive care in military hospitals…where have we heard that argument before?

Note: Active duty military personnel are not allowed to file medical malpractice lawsuits….the Times articles states that military leadership fear a breakdown in military discipline if lawsuits were allowed. So, covering up medical mistakes and not meeting the financial and emotional needs of injured soldiers and their families is good for discipline and morale? Gimme a break.

As a US Senator and President, Barack Obama has been a leader in the disclosure movement. Moreover, Obama dramatically changed the military by allowing gays to openly serve. Perhaps during his last months in the White House, Obama can again change the military by advocating for disclosure, apology, and fair compensation to troops injured by medical errors. Don’t our troops deserve the very best?

Here is the link for the New York Times article.

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