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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Question from the Road: Lose a Patient?

Yesterday I did a webinar for a large hospital system, and the following question was posed during Q&A:

“I’m in charge of our system’s ambulance service, and, well, every so often we lose a patient. What do we say to the family when we lose their loved one?”

Wow, what a question, but not that out of the ordinary when you think about it. Fact is things get lost, misplaced, filed incorrectly, etc all the time in health care, except in this instance it’s an actual person that is “misplaced.” Here was my response:

“Tell the truth, but only say what you know when you know it. Don’t be in a hurry to blame the driver, or the person who arranged the transfer, etc, because you don’t know for sure. Instead, simply, ‘We are sorry we lost your husband. We were supposed to take him from Point A to Point B, but somehow he ended up at Point D. I know this is a scary situation, but your husband is secure and OK, and we are getting him to Point B in a quick and safe manner. We are very sorry this happened, and we are going to conduct a review to understand how and why it happened, take corrective measures so it doesn’t happen again, and report back to you. Can we talk again at 2pm tomorrow afternoon so I can update you on our review?'”

We see similar situations in long-term care when items such as clothing, jewelry, etc get lost. Was it stolen? Maybe. If so, who stole it….an employee, another resident, or family member? Or did the resident with memory problems misplace the item or mistakenly throw it in the trash? Possibly. Or did the caring grandson, knowing that grandma is having memory problems, take the treasured watch home for safe keeping and simply not tell anyone, yet? Could be. In this circumstance when confronted with an angry resident or family demanding to know where grandma’s watch has gone, don’t get defensive and simply say, “I am sorry the watch is lost. Let me help you find the watch. Let’s try to see what happened to the watch.”

Then, there is the scenario we role play in disclosure training seminars: A 40-year old woman had a Pap smear in August, then she goes back to her physician in February for another issue, but during that February visit the physician asks if the woman has seen the specialist about her Pap smear. The patient looks dumbfounded: “What specialist? I never heard anything about the Pap smear. Is there something wrong? Nobody told me.” In such a situation, a physician might a) downplay or even cover up the episode, or B) blame her staff for misfiling the report and not calling the patient, or c) say the following: “OK, we had an irregular reading with your Pap smear that raised some concerns and we need you to see a specialist. Somehow, unfortunately, there has been a disconnect between our office and you…I need to understand what happened. I am sorry this happened. The most pressing issue, however, is that we get you to the specialist ASAP…we’re six months behind at this point. I know the specialist and will call in a favor to get you seen soon, possibly today. Also, I will try to understand what happened with your August Pap smear, and report back to you. Can we talk at 2pm tomorrow afternoon? Do you have any other questions? How else can I help you right now? My staff and I are going to stay with you every step of the way.” In this scenario the lab report may have been filed away incorrectly and no one called the patient, OR the office called three times and left messages, but the teenage son deleted all of them, and the husband threw away the letter that came in the mail. You don’t know…so only say what you know when you know it.

For information on Sorry Works! webinars and disclosure training seminars, call 618-559-8168 or e-mail doug@sorryworks.net.

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2nd Victims of Medical Errors and the Disclosure Movement

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

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

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

Personally, I’ve heard one too many stories of clinicians quitting or retiring early, suffering family problems including divorce, and even committing suicide all because they are not given adequate emotional support post-event.   Telling a doc or nurse “the lawyers will take care of it” does NOTHING to address the PTSD they are suffering.

There is a very robust disclosure movement in the United States, and a smaller but growing 2nd victim support movement.  Unfortunately, there is not enough overlap between the two — but the two concepts need to be married together.  We need to support everyone post-event.   Not only do we to talk better to patients and families post-event and treat them in a more humane fashion, the same goes for docs and nurses.  I dedicate an entire chapter in my new “Sorry Works! Tool Kit Book” to this topic (more on the new book next week). 

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

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