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

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

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

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

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

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

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

Special advisor to the board:

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

 

Executive Summary

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

 

History

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

 

New Sources of Revenue for Non-Profit Sorry Works!

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

 

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

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

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

 

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

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

Next Steps

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

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Survey Shows Majority of Physicians Would Not Disclose Missed Cancer Diagnoses

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

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

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

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

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

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

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

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

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

 

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

 

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AHRQ Survey of Nursing Homes — Reporting Mistakes An Issue

nursing-homeThe Agency for Healthcare Quality and Research, or AHRQ, recently released the “2016 Nursing Home Survey on Patient Safety Culture.”

Lots of interesting data in this report, including the not-so surprising fact that administrators/leaders in most nursing homes have a higher opinion of the safety, quality, and excellence of their facilities versus their front-line staff! The question about would you put your loved one in this facility received a much lower score from CNAs, nurses, and physicians versus leadership! There was also a stark difference between leaders and front-line staff concerning the “Communication Openness” of their nursing homes, with 77% percent of leaders responding positively while only 47 percent of staff doing the same.

The survey was completed by 209 nursing homes and over 12,000 long-term care professionals. For readers of this space, the most interesting data in the report was that while 85 percent of respondents felt good about how their facilities discuss safety, only about half felt responses to mistakes was non-punitive. Indeed, how can we expect staff to disclose adverse events if they believe their heads will be chopped off?!? The AHRQ report listed non-punitive responses to mistakes as one of the “areas for potential with improvement for most nursing homes.” Unfortunately, there were no direct questions in the survey about disclosure and post-event communication strategies….this was a missed opportunity.

Sorry Works! has had the pleasure of working with many assisted living and long-term care facilities across the United States. The vast majority of folks who work in long-term care organizations are angels who have a passion for caring for our elderly, and they truly try to do their best every day. Unfortunately, many facilities are understaffed (another improvement area noted in the AHRQ report), most staff have not been trained how to communicate with angry residents and families, and too often staff are blamed, suspended, or even fired when something goes wrong. There’s a lot of work to do. Moreover, nursing homes are being targeted more and more with lawsuits, so there is a good business case for addressing these issues now.

Let’s start from the rear and work forward.

Over the years I have had several conversations with HR managers/directors in nursing homes concerning how staff are often punished when something goes wrong. My “favorite” response is, “Well, we suspend them with pay!” Look, I can understand that we want to remove an emotionally traumatized caregiver from the floor, but we need to support that person emotionally. They are 2nd victims, and they need compassion and support, especially if the event was their fault. Don’t send people home…don’t put the “X” on them with a suspension ….instead, temporarily re-assign 2nd victims to the administrator’s office to do paperwork (or some other task that does put them in contact with residents). Nobody wanted to hurt grandma, but mistakes do happen, and if we are going to learn from those events and provide closure for all sides, we need staff to believe they will be supported post-event. Sure, if the event happened because of immoral or unethical behavior, or if a staff person repeatedly makes mistakes, then termination is certainly warranted, but if an honest, hardworking CNA or nurse is involved in an adverse event, they need support. Bottom line is you have to change or update your HR policies…and this is true for our friends in acute care as well!

Second, front-line staff in nursing need to be taught how to empathize and stay connected post-event with residents and families. With high staff turnover, this can be a challenge in nursing homes, but Sorry Works! has developed content to fill the need. Indeed, the orientation process for every newly hired CNA and nurse in a long-term care facility should include education on empathy and how to stay connected post-event.

Finally, I am glad AHRQ is focusing on nursing homes and medical errors, but I am still puzzled why AHRQ’s recently released Candor Disclosure Tool Kit has zero mention of nursing homes. Their Tool Kit is all about acute care. We at Sorry Works! have written about this significant oversight, but have not received any response from AHRQ or the Candor team. My e-mail is doug@sorryworks.net or you can call 618-559-8168. Moreover, I hope AHRQ will include direct questions about disclosure and post-event communication in future surveys. Questions such as “Have you (or your staff) been trained how to empathize and stay connected with residents and families post-event?” could be very informative.

Here is the link for the AHRQ nursing home survey, and here is a link for a news article on the survey.

Have a great weekend!

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Sorry Works! Featured in HealthLeaders Media & Medical Economics

hl hl2At Sorry Works!, we got our start 11+ years ago with a front-page article in American Medical Association News. That was a coup that led many other prominent articles in Time Magazine, CNN, and countless other popular and trade publications.

We are always appreciative of good media coverage that helps us spread the word and build more support for disclosure. Over the last month, Sorry Works! has appeared in two terrific articles. HealthLeaders Media featured Sorry Works! in this article, and last week Medical Economics included Sorry Works! is another great story that also featured Rick Boothman, Dr. Tom Gallagher, and others.

If you have any type of publication, including your organizational newsletter or blog, that would benefit from an article or content about disclosure & apology, please let us know by e-mailing doug@sorryworks.net or calling 618-559-8168.

 

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Sorry Didn’t Work? Great Teaching Case…

upset-docI recently gave a CME-accredited lecture on disclosure and apology to a group of physicians, and some of the docs in the room had heard my talk or had read my content before. Never mind, it’s always good to review important concepts and we know more about disclosure today than we did five years ago or even a year ago. So, the talk was well-received and everything went fine, until the talk was over and a physician approached me and he was somewhat angry. The doc told me how he believed in Sorry Works! but it didn’t work on a certain case, it cost him money out of his own pocket, and he should have just left the family alone like his partners did with similar complications.

Here’s the story: A surgery did not go as anticipated….the physician claimed it was a well-known complication that was covered during informed consent. Nevertheless, what should have been a brief hospitalization turned into a longer, more scary experience for the patient and her family. The doc said he empathized/said sorry to the patient and family, explained everything to the patient and family, spent at least 15 to 20 minutes with them every day, and, fortunately, they were able to address the complication and eventually get the patient home in good physical condition. The doc felt he did everything right and he (the doc) felt good when the patient was able to go home. The shock for our physician came a month later when the patient showed up in his office, angrily waiving a $10,000 bill in his face, and demanding that he (the physician) pay it. The doc felt “pissed off” by the entire episode, he paid $3,000 out of his own bank account, and his insurer picked up the rest. After the surgeon gave money to the patient, she (the patient) told him she never would have sued him! The doc finished by saying that his partners had similar complications with other patients, did little to no communication with the patients/families, and never had a problem. He felt burned by the entire experience. Sorry didn’t work!

What would you say to this physician? How would deal with his anger? This is a good teaching case…

I have shared this case with subsequent audiences, and received many good responses. One physician said he would have told the woman and her family before they left the hospital that since it was a known complication — NOT an error — there would be a bill coming. Invoices from hospitals and physicians can be upsetting even under the best circumstances, so try to prepare them and lessen the blow when a complication occurs. Several other physicians said they would try to speak to the billing department at the hospital to see if charges can be reduced in some way. Another physician said at least the patient came back to the physician with her problems, as opposed to visiting a lawyer or someone else (state regulator, member of the media, etc). A couple other docs wondered aloud what could have happened had the surgeon not stayed connected with the patient and her family! All good ideas and responses…

My reply to the upset doc was that I wouldn’t have paid the bill. Again, I would empathized — “I am sorry you are upset about the bill and the complication you experienced” — and explained to her why she received a bill (there was no error, this was a known complication we covered during informed consent), but, that would have been it. At some point, I would have told the patient that we agree to disagree, the bill is valid, it should be paid in a timely fashion, and ended the meeting — and documented the conversation. If the patient wants to visit a lawyer, that’s fine, but you have removed all the “gotcha” factors that make cases attractive to a trial lawyer.

We don’t apologize — admit fault — and pay money when we did NOT make a mistake. Now, I fully realize that some physicians and practices or hospitals will wave bills under certain circumstances as a business or PR move, or because they simply don’t want the hassle. I get it. However, clinicians need to understand that it is OK to disagree with patients/family at the end of the disclosure process. We want you to empathize post-event and stay connected with your patients and families, but if the care was solid then that needs to be communicated to the patient/family….and that’s it. Disclosure is a not open-ended invitation to circular conversations, never ending verbal beat downs, or obligations to wave bills or offer money every time a patient or family is unhappy. If informed consent is done well, and post-event reviews are conducted in a credible fashion and the care is shown to be solid, many patients and families will understand and appreciate your empathy and willingness to stay connected post-event, but for those who don’t you can always agree to disagree.

Again, this is a very good teaching case to share with your colleagues as well as students. We have many more teaching cases for both acute and long-term care professionals in the Little Book of Empathy and the Sorry Works! Tool Kit Book. To order copies today, simply click on this link.

 

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Disclosure Not a Risk Management Tool? Not About Avoiding Lawsuits?

confusedI have often heard friends and colleagues in the disclosure movement claim that disclosure is not a risk management tool. Nor is it about avoiding lawsuits, say these well-intentioned souls. They assert, instead, it’s all about doing the right thing, or strictly for patient safety purposes.

Huh?

There is even a group of healthcare professionals who have attempted to rename disclosure — or Sorry Works! — as “Communication and Resolution” or Communication & Resolution Programs, or CRP for short. These folks claim their CRP slogan is more descriptive, but they also swear it is a patient safety program, not a risk management tool.

I am sorry, but the very word “resolution” in a healthcare setting (acute or long-term care) typically implies risk, claims, legal, or c-suite (i.e, the usual suspects in a med-mal case). Sorry, guys….”CRP” screams risk management.

Moreover, when we claim disclosure is not a risk management tool or is not focused on reducing litigation, I think we are being incredibly dishonest with ourselves and our patients and families, and straining our credibility with the plaintiff’s bar. If we are truly going to be transparent, then let’s be transparent with our intentions, desires, and goals. Some of our brightest stars — Boothman, McDonald, etc — have publicly touted their claims data and reduction in lawsuits before the media, government officials, and healthcare, insurance, and legal professionals, so, how can we in a credible way spin around and say, “Oh, no, disclosure has nothing to do with risk management or avoiding lawsuits…it’s just…er….well…..a patient safety program!”

Please…

This makes us look deceptive to consumers and trial lawyers, and also sends confusing messages to the population of healthcare, insurance, and legal professionals who still need to be converted to the disclosure movement.

If you really wanted to be cynical, a person could suggest that this whole notion of disclosure being just a patient safety program is nothing more than a big rip-off for patients and families. You know, tell the family you’re sorry and show how the mistake will never occur again, play to their altruistic emotions, and, gee, maybe we can get out without paying a nickel for claims that do have economic value. Just sayin’….

To be totally transparent and honest from my end, I get really scared when doctors and lawyers experiment with marketing and public relations. Marketing for most docs is a billboard proclaiming their greatness or they are accepting new patients…and have you looked at lawyer websites or advertisements lately?

For God’s sake, quit playing games with words — that’s what lawyers have done far too long with med-mal — and just be honest with patients, families, the public, the trial bar, and ourselves. Disclosure IS about risk management and reducing the need for litigation, but in an ethical and fair manner.

I think the person who best addressed this topic was disclosure advocate Leilani Schweitzer when she penned a column for Sorry Works! In that column (I am paraphrasing), Leilani wrote that yes, we are trying to avoid lawsuits, but we are not trying to avoid responsibility. Here’s Leilani’s column.

You know who else is trying to avoid litigation? Patients and families! Litigation is fun for nobody, and, as a family member, if I hear that a hospital or nursing home has a pro-active risk management department that wants to meet my emotional and financial needs, I will say hooray. Be honest with people.

Yes, disclosure has incredible ramifications for patient safety, but it does so because we effectively address the litigation issue, which is a huge impediment to patient safety. To avoid litigation and increase patient safety, we need to get people talking post-event, and nothing does that better than disclosure. Let’s just be honest about what disclosure is…

The disclosure movement should not run from its risk management roots, we should proudly share the claims data, and we should not be embarrassed or ashamed about diminishing the need for litigation. It’s called being smart….we just have to be honest about it.

Sorry Works! offers CME-accredited presentations for Grand Rounds and meetings — call 618-559-8168 or e-mail doug@sorryworks.net for more information — and we have terrific disclosure content for sale — click here to order.

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Story About Spilled Paint & How We Treat Staff Post-Event..

spilled-paintRecently I got my son, Will, age 10, away from the video games. He used to come home from school and do nothing but stare at a screen and plunk away on keys.  To tear him away from these games was always a fight, so, one day I said “enough” and we quit cold turkey. Now, this intelligent young man gets off the bus and constructs models. It’s wonderful to see him use his imagination and be persistent in building WWII model ships — and he’s doing it without any help from me!  It’s just really cool.

One problem, though: Will continually forgets to change into play clothes before working on his models. Plastic model glue and paint are an anathema to school clothes. Yesterday afternoon Will came running up to my office in a panic, and explained that he had just spilled paint on his new shirt, he had thrown the shirt in the washer, and needed my help to fix it. Naturally, being the great father I am, I yelled at Will. He burst into tears and stomped off to his room, muttering that he would never work on models again. I felt like crap.

img_0709So, I grabbed the shirt out of the washer, thankfully the paint was still very wet, and I was able to wash it out in the sink. New shirt saved. Problem fixed, sorta. There was still the matter of the crying 10-year old and the father who bit his head off.  Full disclosure: There have been prior instances where Will immediately alerted me to a mistake or error in his judgment and I barked at him.  Now, I don’t want to give the impression that Will is a complete angel…..far, far from it…..yesterday morning Will arose early and raided the Halloween candy, and tried hiding the wrappers under the pillows in the couch.  The dog ratted him out. So, regarding the paint incident (and prior confessions), I apologized to Will. I told him I was sorry for yelling at him when he immediately confessed an error to me and asked for my help. I told him that I appreciated him sharing problems with me quickly because it gives us a chance to fix the error or lessen the damage.  I said, however, there was still the issue of Will forgetting to change clothes before working on models, and that behavior had to be fixed or there would be consequences going forward. Also, I contrasted this situation with Will shoving candy wrappers under the couch cushions. Will understands going forward that I will react much differently if mistakes are hidden.

How are you behaving when your clinicians share mistakes? Are you “bad Doug,” or “reformed Doug?” Are you approachable, or are you punitive? I know this is a big issue in the long-term care industry where people are routinely suspended or even fired for being involved in mistakes. Have you communicated to your staff how they should expect to be treated when reporting an error or mistake? Have you brought your HR people into this discussion? Do the HR folks understand this issue??  Is this topic enshrined in your disclosure policy?  Your success at disclosure will depend on your staff’s willingness to disclose errors to leadership. If the culture is believed to be punitive, good luck.

We cover these issues extensively in the Sorry Works! Tool Kit. The Tool Kit literally covers everything you need to know to launch and sustain a successful disclosure program. To order the Sorry Works! Tool Kit, simply click on this link.

 

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Online Disclosure Training Courses from Sorry Works! & The Sullivan Group

TSG logo with arc RGB blueSorry Works! has proudly partnered with The Sullivan Group to produce and market online disclosure training courses for front-line staff and leadership. Your staff will learn how to:

  • Empathize and stay connected with patients/families post-event without prematurely admitting fault.
  • Stay connected with patients and families post-event.
  • Resolve complaints big and small in a fair manner to all stakeholders.

Our online courses include:

  • Fundamentals: Communication and resolution cases, videos, checklists, and much more
  • Empathy Post-Event: Exploration of empathy’s effect on families and yourself post-event
  • “Just-in-Time:” 12-minute video covering the basics for new staff or current staff who need a quick refresher before talking with a patient or family.

All courses are CME-accredited and a learning management system allows you to track the usage and test scores of your staff.

For more information, you can view this webinar link which more fully explains the Sorry Works!-Sullivan Group courses. To schedule a free demo of our on-line courses, simply respond to this e-mail (doug@sorryworks.net) or call 618-559-8168.

We look forward to hearing from you!

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Full Disclosure Documentary “Outtakes” — Handoffs

handoffDuring the development of the Full Disclosure Documentary, filmmaker Lawrence Kraman interviewed lots of interesting people with many different stories and experiences to share. Unfortunately, a lot of material did not make the final version of the film — it’s impossible to fit every viewpoint and story into a 90-minute film. However, there is so much value and learning in many of these interviews that we are going to begin sharing “outtakes” with you.

Today’s outtake features Sean Mahar of Baystate Health in Massachusetts. In the Full Disclosure Documentary, Sean shared his own story of medical error. However, Sean is also an expert on handoffs between medical professionals. So, here is Sean’s outtake on handoffs.

To learn more about Sean’s expertise and consulting on handoffs, visit his website.

To purchase the Disclosure Documentary as part of the Sorry Works! Tool Kit ($49.99) or individually ($29.99), simply click on this link.

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Additional Thoughts — Physician Lied During Med-Mal Trial

sweating-to-tell-the-truthShortly after this column was released last Saturday (original column with links below), a plaintiff’s attorney friend of mine took me to task (and rightly so).  He said my column downplayed the fact that the physician in this article did more than “lie” or commit an immoral act…the physician intentionally committed the felony crime of perjury and further injured the plaintiff and his family.  My plaintiff’s attorney friend blasted the excuse given by the offending physician that he (the doctor) felt obligated to lie because of his employment contract.  My friend stated that no employment contract can require any employee (physician or otherwise) to break the law, and no court in the land would honor such a “contractual obligation.” 

Share this with your physician friends….this is an important topic, just the same as the fear of losing medical malpractice coverage due to disclosure.   Countless times we’ve heard the excuse from physicians that the medical malpractice insurer said “no to disclosure” or the insurer will cancel my coverage if I tell the truth.  We dispelled those myths awhile back at here and here.   

Which brings me to the point for writing this follow up column: Healthcare professionals can do some crazy and even illegal things post-event because they have not been trained!  For too long, physicians, nurses, and other clinicians have operated in a literal information vacuum post-event, and they are left to figure it out on their own with rumors, half-truths, and what they have heard from their colleagues (who don’t know any better themselves!).   Too often, doctors and nurses run away and hide, say the wrong things or the right things in the wrong manner, speculate or joust, promise the moon, act cold and callous, or….perjure themselves!   We need to stop this, and the good news is training your staff on disclosure helps your bottom line.

A great place to start training your front-line staff is the with the Little Book of Empathy.  Priced from $4 to $9 per copy (depending on your volume), the Little Book of Empathy teaches the disclosure basics to any clinician in 30 minutes or less.  To order copies, click on this link. 

Sorry Works! also makes for a great Grand Rounds presentation for your physicians, nurses, and front-line staff. To learn more about CME-accredited Grand Rounds presentations from Sorry Works, call 618-559-8168 or e-mail doug@sorryworks.net.

Sincerely,

– Doug

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

Physician Lied During Med-Mal Trial (originally published September 22, 2016)

A retired surgeon recently confessed in a newspaper column that he lied under oath to protect a colleague during a medical malpractice trial nearly two decades ago. Dr. Lars Aanning, age 77, published his column last month and then provided an interview for ProPublica.

Dr. Aanning said he felt pressure to protect his colleague, even though a mistake had been made during the surgery that led to the patient being crippled. He said this pressure for doctors to protect one another comes from professional societies like the American Medical Association down to hospitals and individual practices. It’s the doctors against the lawyers, stated Dr. Aanning, and, at the time he didn’t feel like he was lying but more so just supporting a colleague — even though at the time he had doubts concerning the surgical abilities of his colleague.

The plaintiff lost the case, and Dr. Aanning says his lie under oath haunts him. Today, he is a patient safety advocate and works with plaintiff’s attorneys on medical malpractice cases, but Dr. Aanning clearly states there is no level playing field for injured patients in a courtroom. Dr. Aanning wishes for a better way than the legal system to resolve medical errors.

There is a better way…it’s called disclosure and apology. We’re making great progress, but, let’s not fool ourselves. Dr. Aanning’s column is a stark reminder of the deeply embedded culture we are trying to change. When Sorry Works! started 11+ years ago, disclosure was literally a four letter word. We’ve changed that perception, but there are still many claims and legal professionals who are stuck in the old mind set, and we still have not provided adequate disclosure training for front-line clinicians in acute AND long-term care settings. So, when a crisis hits, it’s easy for doctors and nurses to fall back into cover up mode and for the folks in claims and legal to reinforce this bad behavior.

We need to continue developing and refining disclosure and apology programs. A big part of any disclosure program is sending a different message to our doctors and nurses: “We support you post-event, we want you to tell the truth, and we will get everyone — patient, family, and clinical staff — through the event. There is no problem too big for us to handle. Just tell the truth!” Internal and external PR is a big part of any successful disclosure program. We talk about this extensively in the Sorry Works! Tool Kit.

Disclosure starts at the bed side with clinicians empathetically communicating with patients and families after something goes wrong. This doesn’t happen by accident…clinical staff need to be trained how to communicate post-event. This is why we have sold thousands of copies of the Little Book of Empathy. The Little Book of Empathy, priced from $9 to $4 per copy, provides samples scripts for post-event conversations, cases, and check boxes for clinicians, and can be read in 30 minutes or less.

Here is the link to Dr. Aaron’s column and also a link to his ProPublica Interview.

If you need any assistance from Sorry Works!, call 618-559-8168 or e-mail doug@sorryworks.net.

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