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Not All VA Hospitals Disclosing Errors…Surprised?

An article was recently published in the Tampa Bay Times saying – in short – that despite a national reputation as being a leader in disclosure of medical errors, not all VA Hospitals are following the VA’s national policy of disclosing medical errors.  In fact, the Times article implied very few patients/families are receiving disclosure and apology from VA facilities.

My response: I am not surprised, and, within the disclosure world, I’m not sure this is earth shattering news.

Look, to be absolutely candid, you could write almost the same article about any hospital in the United States, because around 2001 JCAHO told hospitals they needed disclosure policies, and most complied.  Again, so what?  Sometimes when I speak at a hospital I will hold up a copy of the JCAHO-inspired disclosure policy and ask how many doctors & nurses know the policy even exists?  Usually only a few hands go up.   I will then ask those with their hands up to continue to keep their hands up if they have actually read their hospital’s disclosure policy.  Almost always all the hands go down.   When I read these disclosure policies, they appear to be written by lawyers for the benefit of lawyers.  Absolutely worthless.  No wonder we have so many doctors and nurses not knowing what to say post-event, no idea who to call for help, etc, etc. 

Dr. Steve Kraman and Ginny Hamm, JD did an awesome job at the VA Hospital in Lexington, KY several years ago.  They had a good disclosure program, and their work became the template/model for disclosure programs at many other hospitals and insurers.  Kraman and Hamm received much well-deserved praise as did the VA System for giving them the ability to do this work.  I believe Kraman and Hamm’s work also was the reason for the disclosure policies within the VA and by JCAHO….but there is a world of difference between a policy and a program.   Not enough private hospitals and VA hospitals have disclosure programs.  We have a lot of work to do.

You need to have a program…a program that raises awareness within the institution from c-suite to front-line staff, provides the necessary training for all staff, and the institutional follow-through when adverse events happen.  If all you have is a policy the Tampa Bay Times could write the very same article about your hospital (or insurer).   You need a program, and the best part is the cost of developing a program will be recouped by stopping just one lawsuit.

To help train your front-line staff, be sure to get some copies of the newly released “Pocket Notes.”  Adapted from the successful Little Book of Empathy, Pocket Notes will in a few minutes teach the basics of empathizing and staying post-event without prematurely admitting fault.  To order,click on this link.

Finally, here is the link for the Tampa Times story.

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Oregon Hospital Apologizes for Fatal Medication Error, Shares Details

An Oregon Hospital recently apologized in person with the family and in writing for a fatal medication error that took the life of 65-year old Loretta Macpherson. The hospital apparently gave the Mrs. Macpherson the wrong drug. Here is text from a letter released by the hospital:

“On Monday afternoon, a tragic medication error occurred at St. Charles Bend that ultimately caused the death Wednesday of a 65-year-old patient. The St. Charles family is devastated by this situation and our thoughts and prayers go out to the patient’s family along with the caregivers who were directly involved in this case during this incredibly difficult time.

“As soon as the error was recognized, we met with the patient’s family to explain what had happened and apologized for the grave mistake. We are in the process of investigating the cause of the error and are working closely with our internal team to ensure that it will not happen again. We will be reporting the event to The Joint Commission and the Oregon Patient Safety Commission in the coming days. St. Charles has never experienced a medication error of this kind in its history.

“The caregivers directly involved in this patient’s situation are on paid administrative leave while the investigation continues. They are long-term caregivers who have provided compassionate and skillful care throughout their careers.

“All of us have chosen health care as a career because we have a heart for serving people. When a patient is harmed on our watch it affects us deeply.

“We are committed to handling this tragedy in a transparent and responsible manner that takes into account the needs of the patient’s family, our family of caregivers and our community.

Dr. Michel Boileau
Chief Clinical Officer
St. Charles Health System”

 

***********************

THEN, this more detailed analysis of the situation, what went wrong, and how errors would be fixed was shared with the public and the media:

 

Results of Medical Error Investigation

Press Conference Statement – Dec. 8, 2014

As you are well aware, a tragic medication error occurred here last week that resulted in the death of Loretta Macpherson. All of us at St. Charles are devastated by this event. Our thoughts and prayers are with Ms. Macpherson’s family and friends during this incredibly difficult time.

After completing our root cause analysis – or internal investigation – we have a more detailed understanding of what led to the medication error.

I would like to first say that while human mistakes were made in this case, we as a health system are responsible for ensuring the safety of our patients. It is the executive leadership team’s responsibility to ensure that processes are in place and those processes are followed. No single caregiver is responsible for Loretta Macpherson’s death. All of us in the St. Charles family feel a sense of responsibility and deep remorse.

  1. On Monday, Dec. 1, Loretta Macpherson came to the St. Charles Bend Emergency Department for treatment following a brain surgery at Swedish Medical Center in Seattle. The physician who cared for Ms. Macpherson here ordered fosphenytoin, an anti-seizure medication, to be administered intravenously.
  2. The drug was correctly entered into the electronic medical records system and the correct order was received by the inpatient pharmacy.
  3. The order was read in the inpatient pharmacy, but an IV bag was inadvertently filled with rocuronium – a paralyzing agent often used in the operating room.
  4. The label that printed from the electronic medical records system and was placed on the IV bag was for the drug that was ordered – fosphenytoin – although what was actually in the bag was rocuronium.
  5. The vials of rocuronium and the IV bag that was labeled “fosphenytoin” were reviewed without the error being noticed.
  6. The IV bag was scanned in the Emergency Department, but because the label on the bag was for the drug that had been ordered, the system did not know to sound an alarm.
  7. The bedside caregiving staff had no way of knowing the medication within the bag was not what had been ordered.
  8. Shortly after the IV was administered to Ms. Macpherson, a fire alarm, known as a “code red,” sounded due to an issue in the Heart and Lung Center.
  9. A staff member closed the sliding door to Ms. Macpherson’s Emergency Department room due to the code red to protect her from potential fire hazards.
  10. The paralyzing agent caused Ms. Macpherson to stop breathing and to go into cardiopulmonary arrest. She experienced an anoxic brain injury. She was taken off of life support on Wednesday morning and died shortly thereafter.

Next Steps:

Since Ms. Macpherson’s death, we have taken several immediate steps to ensure that an error of this kind will not happen again in our facilities.

Issue 1: Incorrect drug chosen and placed into IV

Our Response: We are enforcing a “safety zone” where pharmacists and techs are working that is intended to eliminate distractions. Verification of medication can only be completed in these areas.

Issue 2: Verification of drug dispensed

Our Response: A detailed checking process has been standardized and implemented to bring heightened awareness to the pharmacy team. New alert stickers have been added to paralytic medications and we are training nursing staff to watch for these stickers.

Issue 3: Monitoring of patient after IV started

Our Response: Nursing leaders are currently evaluating patient care processes to ensure we are following best practices. On every unit, our nurses are being hyper-vigilant about how we administer any intravenous medications. We are conducting frequent check-ins with our patients and we are consulting with patient safety experts across the country to ensure we are adhering to best practices.

Additional steps are forthcoming including bringing in an external pharmacy expert to review our internal processes and provide recommendations for improvement.

 

*******************************

From a disclosure prospective, this looks and feels like the hospital is doing everything right. I’m impressed. There are no weasel words, no hedging in either letter. They appear completely transparent, apologetic, and ready to fix problems — which what most grieving families want. I hope going forward that the hospital and their attorneys work quickly to address the financial and emotional needs of the family and thus avoid litigation. I also hope they provide adequate support for their staff, including the opportunity for staff directly involved in the mistake to meet with the family and personally apologize. Lastly, I hope when the financial and legal aspects of the case are concluded, that the hospital and family will share their disclosure story with the world.

Good disclosure starts with your front-line staff. Sorry Works! new disclosure teaching tool for front-line staff is called “Pocket Notes.” This compact, tri-fold brochure is a basically a summary of The Little Book of Empathy and can be quickly reviewed by busy doctors and nurses. Teach your docs and nurses how to empathize and stay connected post-event without prematurely admitting fault with Pocket Notes. To order Pocket Notes, click here.

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Pocket Notes Available for Front-Line Docs & Nurses

Over the last four years Sorry Works! has sold thousands of copies of The Little Book of Empathy…..this short booklet is a great tool for disclosure team leaders, physician leaders, and nurse managers. Now we have developed “Pocket Notes” for front-line staff which summarizes the most critical details from the Little Book of Empathy.

In a few minutes, Pocket Notes will teach your docs and nurses the basics of empathizing and staying connected post-event without prematurely admitting fault. Small and economical, Pocket Notes is a must have for all of your front-line staff. Pocket Notes will raise disclosure awareness among your clinicians, and help them through difficult post-event discussions.

To order copies of Pocket Notes and also the Little Book of Empathy, visit this link.

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Two New Studies on Disclosure and Apology

Welcome back from Thanksgiving Break! Hopefully everyone had a restful holiday.

Two new studies were recently covered by trade publications. One study says that only 11% of patients/families who experience harm receive an apology from a healthcare organization. This study was based off a survey administered by ProPublica, and while I don’t doubt that most consumers still do not receive apologies, I really question the efficacy and strength of a survey conducted by ProPublica on this subject. I’ll leave it at that…

The second study was more of a ethical discussion about disclosure in the Journal Pediatrics. The authors presented the following case in their paper which the trade media picked up on:

“A four month old, former 23 week preemie; several weeks of high-frequency oscillating ventilation and vasopressor infusions; multiple operations for complications of necrotizing enterocolitis; docs suggested, but mother refused DNR. Following slight improvement, condition worsened. Evaluated for sepsis, started antibiotics, back on ventilation. Baby went into cardiac arrest.

A radiologist noted, on a chest radiograph taken during the resuscitation, that SP’s central line was in her aorta and not in a central vein as it should have been….[Baby's] decline over the past several days and her cardiac arrest were likely the result of arterial emboli from her central line and the administration of medications directly into her arterial system….consistent with severe hypoxic ischemic injury.

Should the docs have recommended the DNR? And how much should they tell the mother about the misplaced line?”

So, how would you and your clinicians handle this type of case? What would you say, and not say? Who would do the talking, where, and when? And lots of other questions….

When teaching disclosure to clinicians, I present them with cases such as the one above and I find there is a still a lot of hesitancy to respond to the cases in any fashion. It’s often stony silence, uncomfortable eye contact, papers being shuffled, etc. Clinicians are not sure how and when to address the clinical aspects of the case, and often have no idea (or appreciation) for how to handle the emotional aspects of the case. So, we get lots of silence, and consumers feeling like they are being abandoned by their doctors and nurses which can increase the chances for litigation and other forms of revenge.

At Sorry Works!, we teach in the immediate aftermath of an event to first address the emotional aspects of the case because the medicine or science has failed us (error or no error). We tell docs and nurses to literally become impromptu grief counselors, and show them how to do it. How to be a presence for a family that is hurting. Moreover, we tell docs and nurses that no one is really ready to talk about the specifics of a case in the immediate aftermath of an event. Docs and nurses often don’t have the facts together or they are acting on hunches, and the family is not really ready to listen and process, even if they are demanding answers. Instead, stick to empathy and address emotional needs as well as customer service necessities (food, lodging, transportation, minister, etc)…plenty of time down the road to discuss the scientific stuff. We also talk about the importance of not getting stuck in circular conversations or debates with patients and families, but needing to keep open the lines of communication and maintain the relationship with your customers.

Unfortunately, too many clinicians have not received this simple training and they continue to struggle with post-event discussions. We know finances are tight in healthcare and schedules are jam-packed, but if you stop just one lawsuit, then disclosure training pays for itself. Literally.

As we close out 2014, let’s make disclosure more of a priority for 2015 so that the next time ProPublica or some other group conducts a survey they receive a much different response about apology. Lots of work to do but it’s worth the investment.

Here is the link for the ProPublica based study, and here is the link for the article on the Pediatrics study.

Welcome back from Thanksgiving Break! Hopefully everyone had a restful holiday.

Two new studies were recently covered by trade publications. One study says that only 11% of patients/families who experience harm receive an apology from a healthcare organization. This study was based off a survey administered by ProPublica, and while I don’t doubt that most consumers still do not receive apologies, I really question the efficacy and strength of a survey conducted by ProPublica on this subject. I’ll leave it at that…

The second study was more of a ethical discussion about disclosure in the Journal Pediatrics. The authors presented the following case in their paper which the trade media picked up on:

“A four month old, former 23 week preemie; several weeks of high-frequency oscillating ventilation and vasopressor infusions; multiple operations for complications of necrotizing enterocolitis; docs suggested, but mother refused DNR. Following slight improvement, condition worsened. Evaluated for sepsis, started antibiotics, back on ventilation. Baby went into cardiac arrest.

A radiologist noted, on a chest radiograph taken during the resuscitation, that SP’s central line was in her aorta and not in a central vein as it should have been….[Baby's] decline over the past several days and her cardiac arrest were likely the result of arterial emboli from her central line and the administration of medications directly into her arterial system….consistent with severe hypoxic ischemic injury.

Should the docs have recommended the DNR? And how much should they tell the mother about the misplaced line?”

So, how would you and your clinicians handle this type of case? What would you say, and not say? Who would do the talking, where, and when? And lots of other questions….

When teaching disclosure to clinicians, I present them with cases such as the one above and I find there is a still a lot of hesitancy to respond to the cases in any fashion. It’s often stony silence, uncomfortable eye contact, papers being shuffled, etc. Clinicians are not sure how and when to address the clinical aspects of the case, and often have no idea (or appreciation) for how to handle the emotional aspects of the case. So, we get lots of silence, and consumers feeling like they are being abandoned by their doctors and nurses which can increase the chances for litigation and other forms of revenge.

At Sorry Works!, we teach in the immediate aftermath of an event to first address the emotional aspects of the case because the medicine or science has failed us (error or no error). We tell docs and nurses to literally become impromptu grief counselors, and show them how to do it. How to be a presence for a family that is hurting. Moreover, we tell docs and nurses that no one is really ready to talk about the specifics of a case in the immediate aftermath of an event. Docs and nurses often don’t have the facts together or they are acting on hunches, and the family is not really ready to listen and process, even if they are demanding answers. Instead, stick to empathy and address emotional needs as well as customer service necessities (food, lodging, transportation, minister, etc)…plenty of time down the road to discuss the scientific stuff. We also talk about the importance of not getting stuck in circular conversations or debates with patients and families, but needing to keep open the lines of communication and maintain the relationship with your customers.

Unfortunately, too many clinicians have not received this simple training and they continue to struggle with post-event discussions. We know finances are tight in healthcare and schedules are jam-packed, but if you stop just one lawsuit, then disclosure training pays for itself. Literally.

As we close out 2014, let’s make disclosure more of a priority for 2015 so that the next time ProPublica or some other group conducts a survey they receive a much different response about apology. Lots of work to do but it’s worth the investment.

Here is the link for the ProPublica based study, and here is the link for the article on the Pediatrics study.

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Additional Thoughts — Hospital’s Letter of Apology for Dallas Ebola Crisis

Dear Readers,

We received a lot of interest in the original e-newsletter below. I guess when you put “Ebola” in the title of anything today people are going to at least give it a look! But, there was earnest feedback and still some angst over letters or any type of “public” documents (e-mail, blog post, etc) of this nature.

Some thoughts to share with you: This letter, although an example of a good communication, should not be a hospital’s only communication with the media and other outside stakeholders concerning the process by which adverse events are handled at your institution. At Sorry Works, we have repeatedly encouraged you to reach out and share your disclosure program with local media, including known healthcare reporters, editorial boards, talk radio, and even prominent bloggers in your area. Discuss with these folks how adverse events were handled in the past, and how they will be handled now. Talk about how disclosure has worked at other hospitals and insurers around the country, and your hopes for disclosure with your hospital. There are many benefits to this approach, including:

  • The next time a reporter receives a tip that your hospital is unsafe, killed X number of patients, etc, the reporter/editor may give you the benefit of the doubt and contact you for a substantive conversation (as opposed to throwing you against a wall).
  • Working with the media is one way to educate your patient/family population and local attorneys about your new, ethical approach to adverse events.

 

 

  • It’s truly authentic and unique advertising for your hospital. Who cares if you are a “Top 10 Hospital” according to some survey we’ve never heard of before? The public does not pay attention to that marketing garbage. But, get a story out there how your doctors are human and empathetic and have the integrity to own mistakes, well, now I’m paying attention and might be more likely to use your services. Follow?

“But, Doug, by publicly discussing our disclosure program aren’t we inviting people to come looking for easy pay days?”

Answer: Maybe…but, you know what, anyone who would approach the hospital saying, “Hey, I heard you guys say ‘sorry’ and pay lots of money when people aren’t happy, and my sister didn’t like the care given by her doctor, so where’s our money??” doesn’t need a news story to make this approach to you. They are probably doing it already! And remember to keep the big picture in mind….for every scum bum there will be many more families and attorneys who will learn you are ethical and will be more willing to work with you post-event. Families will understand the door is open following an adverse event, and attorneys will know to call or e-mail before filing a lawsuit. But you have to get the word out there!

Remember, next Thursday, November 13th at 1pm ET/10am PT is our “Train the Trainer” Webinar on Disclosure and Apology. Great webinar for risk, claims, legal, c-suite, and medical and nursing leaders to train them so they can train your docs, nurses, and other front-line staff. Here is the link to register.

Sincerely,

- Doug

Doug Wojcieszak, Founder, Sorry Works!

 

 

Hospital’s Letter of Apology for Dallas Ebola Crisis

October 29, 2014

Dallas Presbyterian Hospital recently took out a full-page ad in a local newspaper to apologize for the Ebola crisis. I shared the letter through Sorry Works! social media outlets (LinkedIn, Facebook, etc) and it gained a lot of traction, so I thought it would be good to share it through this forum.

The letter wasn’t over lawyered, but, instead, it was a candid admission of the hospital’s shortcomings, said sorry, and discussed the changes they will make to ensure the safety of their patients and the community. I think it’s a really good letter. To see for yourself, click on this link. I think this is a good example of disclosure and transparency with stakeholders in the media and the public. I’ve read plenty of weasel letters from lawyers, and this is not one of them. But judge for yourself.

Remember, on Thursday, November 13th at 1pm ET/10am PT, Sorry Works! will be holding a “Train the Trainer” Webinar on Disclosure and Apology. If your organization is considering disclosure and/or your are trying to get your leadership interested in disclosure, this webinar will help the cause. Great training webinar for risk, claims, legal, c-suite, and medical and nursing leaders. Please join us. Click on this link for registration information. Please join us!

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“Train the Trainer” Webinar on Disclosure – November 13th -

We are receiving great response for this webinar. This “train the trainer webinar” will be a terrific resource for risk, claims, legal, and medical and nursing leaders who want to learn how to teach disclosure to their colleagues. It’s also a good webinar for folks who want to introduce the concept of disclosure to their hospital or insurer.

The webinar will go for up to two hours….about 1 hour of presentation time and up to 1 hour of discussion and questions. You will see and hear the slide deck we use to teach front-line staff in the field, and be educated so you can do the same with your physicians, nurses, and other clinicians.

The cost will be $249 per line, and include five (5) copies of the Little Book of Empathy. You can also receive a taped copy of the presentation for the same cost, or order a live line with a taped copy for $349.

Here is the LINK to register for the webinar. If you have questions, please call 618-559-8168 or e-mail doug@sorryworks.net.

We hope you can join us.

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Sandbagged by Reporter? — Baystate Health Story: Disclosure/Apology Programs & the Media

*** Reminder: Sorry Works! Founder Doug Wojcieszak will be at ASHRM this Sunday through Tuesday at Booth #507, which belongs to our partner The Sullivan Group. Sorry Works! and The Sullivan Group will also be making the Industry Spotlight Presentation on Monday from 12:40pm to 1pm PT in Exhibit Hall C. We look forward to seeing you at ASHRM ***

Since we published this piece below we’ve had a few questions about handling reporters. Most notably, people have wondered what to do if sandbagged or surprised by a reporter? People have wondered if Dr. Benjamin, featured in the e-newsletter and article below, was simply surprised by the reporter’s questions. Yes, you can be surprised by a reporter, but, here are a few helpful tips for handling this situation like a pro.

Remember, you always control your destiny. If a reporter calls you out of the blue with questions or needs a comment, you don’t have to answer on the spot. There is no obligation to do so. If you are not ready to talk, do this instead, “Hi, Mr. Smith, I sure am glad you and The Morning Sentinel are interested in our hospital. I do want to talk with you and answer your questions, but I am running to a meeting right now. What is your story about, and what is your deadline? Either myself or someone else from the organization will call you back.”

Now, you or someone else from the organization must call the reporter back, or it will look like a dodge. However, this approach gives you a chance to scout out the reporter and buys you time to collect your thoughts and assemble any documents you might need.

Prepare to talk with a reporter and be the expert. Whenever you have a phone call or meeting scheduled with a reporter, prepare like you would for a job interview. Think of the questions you will be asked, and have documents organized and at your fingertips. Consider looking at previous articles/stories published by the reporter to get a feel for their reporting style, questions they might ask, etc. Be the expert and own your topic. Reporters are usually generalists, and even reporters who specialize in healthcare, insurance, or the legal world don’t have time or the resources to know your hospital, practice, etc as well as you.

Do their homework for them. There are two types of reporters: Good ones and lazy ones. Neither has the time or the resources to do the homework, gather documents, etc. Do it for them and you will have great control over what goes in the final article.

OK to say you don’t know – but promise to get back to the reporter. Don’t ever try to make up something off the cuff. Never get caught in a lie. Being prepared for the basic questions – like tell us a success story with your disclosure program – is a must…this is where Dr. Benjamin got in trouble below. He didn’t have a story ready to share, and the reporter spun the situation as a bit of a cover up. However, there may be true curve ball questions that come whistling in from left field. Here’s how you handle: “That’s a great question, but I don’t have an answer at this moment. Let me do some research…when is your deadline so I can get you an answer?” Reporters expect you to answer basic questions during an interview, but they will respect you for wanting to do homework on a true curveball (because they hate to be lied to).

OK to follow up after the Interview:  You do the interview, you feel good, but on the car ride home you think, “Boy, I should have said X, or I wish I had brought up Y during the interview.”  What do you do?  Give the reporter a call.  Reporters appreciate people who are conscientious.  “Mr. Smith, I was thinking more about our interview, and I want to add to my answer concerning X….”

Question: But, Doug, what if a reporter really sandbags you? If they literally come jumping out the bushes as you walk to your car and slam with you the following question: “Dr. Jones, I’m Scoop Fredericks from Action 5 News, and two of your former nurses have told us that Memorial Hospital has killed 100 patients over the last two years, and you and your defense lawyer personally have covered up every one of these cases. Can you give us a comment?”

Most people when confronted in this manner will run away, jump in the car, and maybe even give the reporter or cameraman a shove. Don’t do this….because on the six o’clock news they will spin it as you are covering up the truth and everyone including your dog will hate you. Do this instead:

“Hi, Scoop, I am happy to talk with you…please tell your cameraman to stop recording and we will walk back to my office where we can have a discussion.”

Totally disarming. If Scoop keeps filming, he looks like a jerk. If Scoops tell the cameraman to shut it down, this means you are in charge (which you are.) Scoop and you walk back to the office, talk off the record for a while, and when you are ready to make a statement you tell ol’ Scoop it is OK for the cameraman to record again.

Sincerely,

- Doug

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

********************

Original e-newsletter from last week concerning the Baystate Health Story

Below is a story about disclosure at Boston-area hospitals. The reporter interviewed Dr. Evan Benjamin who is the leader of the Baystate Health disclosure program. It’s a pretty good article….Dr. Benjamin said his disclosure program had reviewed 100 cases and decided six cases warranted a full apology. However, unfortunately, Dr. Benjamin was not ready to answer certain questions about his disclosure program. Consider the following section from the article:

“Benjamin, though, was not prepared to be completely transparent in our interview. He would not say how many resolutions included money, nor the amounts, which are paid by the hospital’s insurance — a Baystate-owned company. The hospital also declined to give out contact information for any patients or doctors involved in an error. And Benjamin said he couldn’t remember any case details.

‘I’d have to pull up my data,’ he said during the interview. ‘I’m not prepared to do that…. I’d have to get my staff to pull those particular cases.’”

Ouch!

First rule of dealing with the media is they like stories. Reporters are basically story tellers, and they often want more than facts, figures, and charts. Don’t tell us about how you operate a dog rescue agency that saved 1,000 dogs over the last five years, no, show us Lassie who you found covered on the side of road with three broken legs, covered with dirt, flees, and ticks, nursed him back to health, and then you found a really nice family to adopt Lassie, etc, etc, then tell us about the 1,000 dogs you saved over the last five years and other great facts and figures about your organization. Understand how the game plays? You give something then you get something.

Second, I understand how 100 cases of care that went wrong might translate into only six cases of apology, meaning a compensable error occurred. Personal injury lawyers will understand this batting average too, as most PI lawyers only accept one case out of 100 that walks in the door. However, the public might not understand, and my gut reaction is the average person who reads this article may be thinking those other 94 cases were just covered up. This needed to be wordsmithed and, yes, spun differently. Consider the following:

“During the life of our disclosure program, we have reviewed 100 different cases where the care did not go as planned. In each of those 100 cases we shared the results of the review with the patient or family. Six of the cases actually involved a medical error, we apologized to the patient or family, and worked to resolve these cases in a fair and just manner.”

Here’s another a rough area in the news article:

“Benjamin said during our interview he did not know whether families accepting the hospital’s resolution must agree not to sue, but a Baystate spokesperson later confirmed that is a condition.”

Another rule in dealing with the media is know your facts cold. Be the expert, and part of being the expert is anticipating the questions that will be presented to you and have your answers prepared ahead of time. Otherwise, reporters can become skeptical and think you are not being straight with them.

We have always encouraged you to think of the media (along with regulatory people, PI lawyers, and politicians) as one of the stakeholders in your disclosure program. Don’t be afraid to discuss your disclosure program with reporters and also editorial boards. In fact, talking with reporters is one of the ways we educate our patient/family population about our disclosure programs. However, be prepared for interviews and editorial board meetings. Have stories to share and know your facts cold. Don’t fly by the seat of your pants.

Lastly, when looking at the article below see at the very end of the piece where the reporter asked two other hospitals how they handle medical errors. One hospital would not discuss their approach, and the other hospital said they wanted to do disclosure & apology but the insurance company said no.

Geez….we have so much work to do! In this vein, Sorry Works! is hosting a “train the “trainer” webinar on November 13th at 1pm ET/10am PT. To learn more and register, click here.

Sincerely,

- Doug

Doug Wojcieszak, Founder

Sorry Works!, 618-559-8168

 

*****************************

 

Hospitals Step Up Apology Process Around Medical Errors

by: Karen Brown, NEPR, October 2, 2014

Massachusetts’ Department of Public Health reported 753 cases of serious medical errors at hospitals last year. Patient safety advocates say the best way to reduce medical errors is for hospitals to openly acknowledge mistakes and learn from them. But the fear of malpractice lawsuits has gotten in the way of that. A couple years ago, Massachusetts passed a law that supports a more open apology process. Now, two hospital systems, Baystate Health and Beth Israel Deaconess, are taking that process one step further.

Historically, if a patient was given the wrong medication, or had the wrong leg operated on, or suffered from some other medical misstep, most hospitals would kick into a mode known as ‘deny and defend.’

“There was really quiet about what happened,” says Dr. Evan Benjamin, who oversees patient safety at Baystate Medical Center in Springfield. “And the only way for patients to get attention around what they believe was a medical error was to sue the organization.”

Benjamin says ‘deny and defend’ rarely gets patients or doctors any closure, and it doesn’t make hospitals safer. So he and his colleagues wanted a better approach — one that addresses what he says patients and their families really want after a medical error.

“They want the truth,” he says. “They want to know what happened, and how they’re going to be care for. They want an apology,……They want to know what’s been learned so it won’t happen again. And finally, …they’d like to understand about compensation for experiencing a medical error.”

In 2013, Baystate and Beth Israel launched an effort that Benjamin says offers all those components. The CARe program — which stands for communication, apology, and resolution — was modeled after an approach pioneered at the University of Michigan. Over the past 14 months, Benjamin says, Baystate administrators reviewed 100 cases where the care did not go as planned, and decided that 6 of them warranted an apology and resolution. Benjamin says this came after a decade of encouraging doctors and nurses to report their mistakes or near-misses within the hospital.

“Once you have a culture where you’re asking people to report errors and being transparent,” Benjamin says, “being transparent to patients is the next logical step.”

Benjamin, though, was not prepared to be completely transparent in our interview. He would not say how many resolutions included money, nor the amounts, which are paid by the hospital’s insurance — a Baystate-owned company. The hospital also declined to give out contact information for any patients or doctors involved in an error. And Benjamin said he couldn’t remember any case details.

“I’d have to pull up my data,” he said during the interview. “I’m not prepared to do that…. I’d have to get my staff to pull those particular cases.”

But later in the interview, Benjamin did recall one of those cases — in which an elderly woman’s medication was mismanaged after she was transferred to a nursing home. He says, in that case, the family accepted a resolution — without money.

“It was really about how that family wanted to make sure they were involved in the improvement of when patients are transferred. how can that be improved,” he says. “They wanted others to hear what happened. and then we talked about how we could have improved her management as a result of it.”

Benjamin said during our interview he did not know whether families accepting the hospital’s resolution must agree not to sue, but a Baystate spokesperson later confirmed that is a condition. Some malpractice attorneys have suggested this could put patients in a vulnerable position, but Charlotte Glinka, executive director of the Massachusetts Academy of Trial Attorneys, says she wishes more hospitals had similar apology programs.

“We are obviously very much in favor of doctors being forthcoming with their patients about errors or things that are unexpected,” Glinka says.

Glinka’s organization worked on the 2012 Massachusetts law that makes most medical apologies inadmissible in court. It also requires a 6 month cooling off period before a patient’s family can sue a hospital — time that can be used to work on a resolution.

“In some instances that’s going to make sense for the patient to have an early resolution, to not be involved in a lawsuit that could take 3, 4, 5 years,” Glinka says. “But there may be someone who’s very severely injured and what the hospital is offering just may not be adequate.”

Dr. Benjamin says Baystate patients are encouraged to have a lawyer present during the apology meetings. He says five of the six families approached accepted the hospital’s resolution — and one decided to sue instead. But he says the hospital is not just trying to avoid lawsuits.

“Honestly, the motivation has been to improve patient safety, to do the right thing, by our patients and families,” he says.

And to do right by doctors. Benjamin says he cannot point to any specific safety improvements that have come directly out of the CARe program. But he says doctors and administrators are learning how to conduct better apologies.

“A good apology is one from the heart,” Benjamin says. “It’s an apology for the experience — an apology that says, ‘I made a mistake. We made mistake. We are sorry for that.’ As opposed to an apology which is – ‘I’m sorry that happened to you.’”

Insurers have done studies that show effective apologies can reduce the number of lawsuits, although Stephanie Sheps of Coverys Insurance — which supports the CARe approach — says they still expect to pay the same amount in settlements.

“The real benefit financially comes to the efficiency, of being able to resolve claims more quickly,” Sheps says.

Sheps says insurers that used to be skittish about too much disclosure are now embracing apology and resolution programs. That’s good news to patient advocates. Paula Griswold of the Massachusetts Coalition for the Prevention of Medical Errors says she’s hoping more openness leads to safer hospital practices — though it may take a while.

“I think what everybody is aiming for is….more reporting of events,” Griswold says, “and a greater sense of safety among the clinicians that they won’t have their career destroyed.”

So far, apology and resolution is not yet standard practice. A Berkshire Medical Center spokesperson says he’s never heard of the CARe program, and was not willing to say what kind of approach the hospital takes with medical errors. The patient safety director at Cooley Dickinson Hospital in Northampton says they’ve moved towards a more open apology process, but as for resolutions offered by the hospital — he says their insurance company wouldn’t allow it.

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Sorry Works! at ASHRM — Booth #507 & Industry Spotlight Presentation

Sorry Works! Founder Doug Wojcieszak will be at next week’s ASHRM meeting in Anaheim, CA (October 26th-29th).  Wojcieszak will be at the booth of our partner The Sullivan Group – Booth #507 — Sunday evening and Monday & Tuesday.  Sorry Works! has developed two on-line disclosure training courses with The Sullivan Group.   We have an Introductory/Just-in-Time disclosure training video and a CME-accredited Disclosure Fundamentals course.   Please stop by Booth #507 to learn more about these great courses which teach disclosure to your front-line staff and also new hires down the road in an economical and scalable fashion.

As part of ASHRM, The Sullivan Group and Sorry Works! will be providing an Industry Spotlight presentation on Monday, October 27th from 12:40 to 1pm in Exhibit Hall C.  The title of the presentation is “Empowering Clinicians with Risk, Safety, Quality Solutions,” and the speakers are Brant Roth, Doug Wojcieszak, and Arnie Mackles, MD, MBA, LHRM.  Please be sure to put our presentation on your schedule.

We look forward to seeing many of you in Anaheim next week!

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Baystate Health Story: Disclosure/Apology Programs & the Media

Below is a story about disclosure at Boston-area hospitals. The reporter interviewed Dr. Evan Benjamin who is the leader of the Baystate Health disclosure program. It’s a pretty good article….Dr. Benjamin said his disclosure program had reviewed 100 cases and decided six cases warranted a full apology. However, unfortunately, Dr. Benjamin was not ready to answer certain questions about his disclosure program. Consider the following section from the article:

“Benjamin, though, was not prepared to be completely transparent in our interview. He would not say how many resolutions included money, nor the amounts, which are paid by the hospital’s insurance — a Baystate-owned company. The hospital also declined to give out contact information for any patients or doctors involved in an error. And Benjamin said he couldn’t remember any case details.

I’d have to pull up my data,’ he said during the interview. ‘I’m not prepared to do that…. I’d have to get my staff to pull those particular cases.’”

Ouch!

First rule of dealing with the media is they like stories. Reporters are basically story tellers, and they often want more than facts, figures, and charts. Don’t tell us about how you operate a dog rescue agency that saved 1,000 dogs over the last five years, no, show us Lassie who you found covered on the side of road with three broken legs, covered with dirt, flees, and ticks, nursed him back to health, and then you found a really nice family to adopt Lassie, etc, etc, then tell us about the 1,000 dogs you saved over the last five years and other great facts and figures about your organization. Understand how the game plays? You give something then you get something.

Second, I understand how 100 cases of care that went wrong might translate into only six cases of apology, meaning a compensable error occurred. Personal injury lawyers will understand this batting average too, as most PI lawyers only accept one case out of 100 that walks in the door. However, the public might not understand, and my gut reaction is the average person who reads this article may be thinking those other 94 cases were just covered up. This needed to be wordsmithed and, yes, spun differently. Consider the following:

“During the life of our disclosure program, we have reviewed 100 different cases where the care did not go as planned. In each of those 100 cases we shared the results of the review with the patient or family. Six of the cases actually involved a medical error, we apologized to the patient or family, and worked to resolve these cases in a fair and just manner.”

Here’s another a rough area in the news article:

“Benjamin said during our interview he did not know whether families accepting the hospital’s resolution must agree not to sue, but a Baystate spokesperson later confirmed that is a condition.”

Another rule in dealing with the media is know your facts cold. Be the expert, and part of being the expert is anticipating the questions that will be presented to you and have your answers prepared ahead of time. Otherwise, reporters can become skeptical and think you are not being straight with them.

We have always encouraged you to think of the media (along with regulatory people, PI lawyers, and politicians) as one of the stakeholders in your disclosure program. Don’t be afraid to discuss your disclosure program with reporters and also editorial boards. In fact, talking with reporters is one of the ways we educate our patient/family population about our disclosure programs. However, be prepared for interviews and editorial board meetings. Have stories to share and know your facts cold. Don’t fly by the seat of your pants.

Lastly, when looking at the article below see at the very end of the piece where the reporter asked two other hospitals how they handle medical errors. One hospital would not discuss their approach, and the other hospital said they wanted to do disclosure & apology but the insurance company said no.

Geez….we have so much work to do! In this vein, Sorry Works! is hosting a “train the “trainer” webinar on November 13th at 1pm ET/10am PT. To learn more and register, click here.

Sincerely,

- Doug

Doug Wojcieszak, Founder

Sorry Works!, 618-559-8168

 

*****************************

 

Hospitals Step Up Apology Process Around Medical Errors

by: Karen Brown, NEPR, October 2, 2014

Massachusetts’ Department of Public Health reported 753 cases of serious medical errors at hospitals last year. Patient safety advocates say the best way to reduce medical errors is for hospitals to openly acknowledge mistakes and learn from them. But the fear of malpractice lawsuits has gotten in the way of that. A couple years ago, Massachusetts passed a law that supports a more open apology process. Now, two hospital systems, Baystate Health and Beth Israel Deaconess, are taking that process one step further.

Historically, if a patient was given the wrong medication, or had the wrong leg operated on, or suffered from some other medical misstep, most hospitals would kick into a mode known as ‘deny and defend.’

“There was really quiet about what happened,” says Dr. Evan Benjamin, who oversees patient safety at Baystate Medical Center in Springfield. “And the only way for patients to get attention around what they believe was a medical error was to sue the organization.”

Benjamin says ‘deny and defend’ rarely gets patients or doctors any closure, and it doesn’t make hospitals safer. So he and his colleagues wanted a better approach — one that addresses what he says patients and their families really want after a medical error.

“They want the truth,” he says. “They want to know what happened, and how they’re going to be care for. They want an apology,……They want to know what’s been learned so it won’t happen again. And finally, …they’d like to understand about compensation for experiencing a medical error.”

In 2013, Baystate and Beth Israel launched an effort that Benjamin says offers all those components. The CARe program — which stands for communication, apology, and resolution — was modeled after an approach pioneered at the University of Michigan. Over the past 14 months, Benjamin says, Baystate administrators reviewed 100 cases where the care did not go as planned, and decided that 6 of them warranted an apology and resolution. Benjamin says this came after a decade of encouraging doctors and nurses to report their mistakes or near-misses within the hospital.

“Once you have a culture where you’re asking people to report errors and being transparent,” Benjamin says, “being transparent to patients is the next logical step.”

Benjamin, though, was not prepared to be completely transparent in our interview. He would not say how many resolutions included money, nor the amounts, which are paid by the hospital’s insurance — a Baystate-owned company. The hospital also declined to give out contact information for any patients or doctors involved in an error. And Benjamin said he couldn’t remember any case details.

“I’d have to pull up my data,” he said during the interview. “I’m not prepared to do that…. I’d have to get my staff to pull those particular cases.”

But later in the interview, Benjamin did recall one of those cases — in which an elderly woman’s medication was mismanaged after she was transferred to a nursing home. He says, in that case, the family accepted a resolution — without money.

“It was really about how that family wanted to make sure they were involved in the improvement of when patients are transferred. how can that be improved,” he says. “They wanted others to hear what happened. and then we talked about how we could have improved her management as a result of it.”

Benjamin said during our interview he did not know whether families accepting the hospital’s resolution must agree not to sue, but a Baystate spokesperson later confirmed that is a condition. Some malpractice attorneys have suggested this could put patients in a vulnerable position, but Charlotte Glinka, executive director of the Massachusetts Academy of Trial Attorneys, says she wishes more hospitals had similar apology programs.

“We are obviously very much in favor of doctors being forthcoming with their patients about errors or things that are unexpected,” Glinka says.

Glinka’s organization worked on the 2012 Massachusetts law that makes most medical apologies inadmissible in court. It also requires a 6 month cooling off period before a patient’s family can sue a hospital — time that can be used to work on a resolution.

“In some instances that’s going to make sense for the patient to have an early resolution, to not be involved in a lawsuit that could take 3, 4, 5 years,” Glinka says. “But there may be someone who’s very severely injured and what the hospital is offering just may not be adequate.”

Dr. Benjamin says Baystate patients are encouraged to have a lawyer present during the apology meetings. He says five of the six families approached accepted the hospital’s resolution — and one decided to sue instead. But he says the hospital is not just trying to avoid lawsuits.

“Honestly, the motivation has been to improve patient safety, to do the right thing, by our patients and families,” he says.

And to do right by doctors. Benjamin says he cannot point to any specific safety improvements that have come directly out of the CARe program. But he says doctors and administrators are learning how to conduct better apologies.

“A good apology is one from the heart,” Benjamin says. “It’s an apology for the experience — an apology that says, ‘I made a mistake. We made mistake. We are sorry for that.’ As opposed to an apology which is – ‘I’m sorry that happened to you.’”

Insurers have done studies that show effective apologies can reduce the number of lawsuits, although Stephanie Sheps of Coverys Insurance — which supports the CARe approach — says they still expect to pay the same amount in settlements.

“The real benefit financially comes to the efficiency, of being able to resolve claims more quickly,” Sheps says.

Sheps says insurers that used to be skittish about too much disclosure are now embracing apology and resolution programs. That’s good news to patient advocates. Paula Griswold of the Massachusetts Coalition for the Prevention of Medical Errors says she’s hoping more openness leads to safer hospital practices — though it may take a while.

“I think what everybody is aiming for is….more reporting of events,” Griswold says, “and a greater sense of safety among the clinicians that they won’t have their career destroyed.”

So far, apology and resolution is not yet standard practice. A Berkshire Medical Center spokesperson says he’s never heard of the CARe program, and was not willing to say what kind of approach the hospital takes with medical errors. The patient safety director at Cooley Dickinson Hospital in Northampton says they’ve moved towards a more open apology process, but as for resolutions offered by the hospital — he says their insurance company wouldn’t allow it.

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Risk Manager Remembered Through Donation to Sorry Works!

Sorry Works! was recently contacted by Illinois Risk Management Services (IRMS), which is part of the Illinois Hospital Association. IRMS’ long-time Director of Claims and Risk Management – Mr. Sydney Gross – had passed away, and IRMS wanted to find a way to remember him. Syd was an early supporter of disclosure and apology, so IRMS chose to give Sorry Works! a $1,000 donation in Syd’s memory. In appreciation, Sorry Works! provided to IRMS 100 copies of the Little Book of Empathy customized with a tribute to Syd along with his picture. IRMS distributed the customized books at their recent annual conference.

Donations to Sorry Works! provide the support we need to continue producing our e-newsletters and to keep our website current and useful to our readers. The Sorry Works! e-newsletters are distributed weekly to over 3,000 healthcare, insurance, and legal professionals, and the Sorry Works! website receives over 600 unique visits per day. We encourage you to provide a donation by clicking this LINK.

Below is the tribute to Sydney Gross – we all need to follow Syd’s example. We thank Illinois Risk Management Services for their generous donation in memory of their colleague and friend and we appreciate their continued support of disclosure and apology.

 

“Sydney A. Gross was a pioneer in the fields of risk management and patient safety. He helped to establish the Illinois Provider Trust in 1979 and served as the Director of Claims and Risk Management for the Illinois Provider Trust and Illinois Risk Management Services for 16 years. He advocated for early reporting of adverse events and embraced the philosophy of disclosure to patients long before it became the norm. He believed in early intervention to meet patients’ concerns and being fair but firm. When patients are harmed, they need an apology and Syd always said, ‘Don’t be afraid to say you are sorry.’

Syd believed that a good risk management program does more than just minimize losses, but rather, it enhances quality patient care and safety. He was a leader and innovator in risk management and instilled in many of us a true appreciation of the value of proactive risk management.

He is greatly appreciated for his many years of service and contributions to the field of risk management, and will be greatly missed.

From his friends and former colleagues at Illinois Risk Management Services.”

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