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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Resources for Attorneys Trying to Understand Disclosure

Defense and plaintiffs lawyers are key pieces in any disclosure process, yet, due to lack of knowledge and cultural issues, they can often be barriers — especially defense lawyers.  A few weeks ago I penned a column on fighting passive resistancein disclosure, and it is often the defense lawyers (along with their allies in claims) who provide the most passive resistance to any disclosure program or individual case.  Defense lawyers can throw lots of sand in the gears.  Through the years at Sorry Works! we have stated the some defense lawyers need to be fired.

While some lawyers will never support disclosure (and need to be shown the door), there are many defense lawyers who can become supportive if properly educated.  There are some terrific educational resources for attorneys available through MACRMI, which is the state-wide disclosure initiative on disclosure in Massachusetts.   These resources walk defense lawyers through the process, and even calm skeptical plaintiffs lawyers who think clients might be shortchanged with disclosure.  Check out this link and this link.   Please share this information with the attorneys who will be part of your disclosure program.

Have a great weekend!

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Hotline Numbers on Back of Bathroom Stall Doors

During recent disclosure training seminars, I repeatedly heard from experienced, seasoned doctors that not only do they not have any idea what to say to families post-event, they also have no idea who to call for help when something goes wrong. Of course, the risk manager sitting two rows over is pulling his/her hair out because they have told the medical staff 20 times to call their office when something goes wrong, but the message wasn’t received or remembered. So, docs and nurses don’t communicate with anyone post-event and the situation quickly becomes a legal train wreck.

At Sorry Works!, we continually coach hospitals and insurers that they really need to promote disclosure among their clinicians. It’s not enough to say “We do disclosure” but you have to teach disclosure to your front-line staff and then keep disclosure top of the mind among your doctors and nurses (as well as new hires down the road). One way this is done is to publicize and promote your hotline number to let docs and nurses know there is a place/person to call when things go wrong. A surgeon in a recent disclosure training seminar shared this idea about promoting hotline numbers which was priceless:

“Put the hotline number on the back of the bathroom stall doors. When I sit on the can that is the only five or six minutes of my day where things are totally quiet and I’m not being bombarded by people or information. And all I am looking at is the back of a grey door…so put the hotline number on there. I’ll see it every day and remember it.”

The surgeon also suggested that small cards or pamphlets with information about disclosure (including the hotline number) be left in discreet places where physicians and nurses can quickly and confidentially grab them and stuff in their pockets. This is why Sorry Works! created “Pocket Notes” and the “Little Book of Empathy”…both are small, quick reads that can be customized to include your hotline numbers. Order your copies today!

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Identifying and Fighting Passive Resistance to Disclosure

When I was first giving Sorry Works! presentations 10 years ago, it was not uncommon to have an attorney, doctor, or claims manager stand up and debate me. They would say disclosure was a horrible idea, and then utter some not-so-nice things about me. I don’t have this problem anymore. In fact, I firmly believe if a lawyer or doctor treated me this way today they probably would be fired. We’ve made progress!

However, these detractors have not totally gone away. Yes, some have been converted, but a handful have gone underground. How do you identify them? Well, these folks blow their cover with the following comments:

“We shouldn’t do disclosure on this case…maybe the next case.”

“The doctors aren’t ready for this…..they’re uncomfortable….let’s wait.”

“Pay for the mistake now? We can’t just throw in the towel on this case! Let’s do a few depositions, some discovery, and drag things out…maybe the family or their lawyer will grow tired and quit.”

“You know…we’re so busy around the hospital…we don’t have time for disclosure right now…maybe next year.”

“We’ll say ‘I’m sorry,’ but we’re not paying a nickel.”

“But, I don’t have control over what the nurses will say…I’m uncomfortable with that.”

“Don’t say anything to the family unless a lawyer calls…maybe they’ll just go away.”

“We can’t risk somebody saying the wrong thing!”

You know, a good counter to these comments is to ask, “Well, how would you want your family treated? What if the patient was your wife, child, or sibling?” I once did this to attorney who was trying to throw sand in the gears and he literally slammed down the phone on me.

When you do disclosure you have to do it all the time, and on every case. You can’t cherry pick cases, or play games with consumers or clinicians. Confront the passive resistance, work to bring these detractors into the fold, and, in a few instances, you may have to let some people go. Your disclosure culture is not open to debate or negotiation.

To speed the development of your disclosure program and overcome the hurdles, consider a Sorry Works! presentation for your staff and leadership. For more information, call Doug Wojcieszak at 618-559-8168 or e-mail doug@sorryworks.net.

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Comment from Family About Sending Mail After Adverse Events

Last week we posted about the Jahi McMath lawsuit and, in so doing, drove home the point about NOT sending marketing magazines, bills, fundraising appeals, surveys, etc to families who have suffered adverse medical events — see below for original post. It’s kinda strange when you think about…for the longest time, doctors and nurses have not talked to patients/families post-event, but the hospital happily sends junk mail and bills that only increase the anger felt by families! With disclosure we need to turn this situation on its head. In response to the original post below, a reader left the following response on the Sorry Works! website…it’s a gem:

“YES, YES, YES. When our son Zachary died due to medical negligence, the hospital continued to send us literature “Congratulations on your newborn” “What your 4 month old will be experiencing” etc. We begged them to stop. The fact that one part of the hospital did not communicate with another part to protect grieving parents was agony for us. I would be finally surviving a day of horrendous grief, proud of a smile, that I was able to eat 2 bites of sandwich, unload the dish wahser, that I wasn’t on the ground begging God for my son to be home in my arms and WHAM the mail would come. What that does to a grieving parent is like getting the news again “He’s not going to make it”, “He’s not coming home”, “When do you want to take him off of life support”. And your day, your week is hijacked. Back into the throws of despair you return. You can’t breathe, you wail, you stare catatonic at the piece of mail from the person place or thing that killed your child. And the reality is that it is true “Sorry works!” What a beautiful phrase. I applaud whoever came up with it. After a recent surgery, I almost died at the hospital. I had to have a second surgery, because of a mistake the doctor made. When I awoke from the surgery, my Dr was sitting by my bedside CRYING. He said sorry. It was his fault. He was unaware that an instrument he used cut a whole in my colon, causing waste to enter my body cavity. It almost killed me, a fact that was so hard for my husband and Mother to witness 5 yrs after his son, her grandson had died because of medical negligence. But the Dr. said sorry and a peaceful wave of forgiveness washed over us all, immediately. ‘Sorry works!’”

When I speak before hospitals, I often have risk managers saying, “If I can just get my docs and nurses to say ‘sorry’ after an adverse event and call risk or legal we’ll be miles ahead…these are simple things.”   Add not sending mail or bills to the family post-event to the list of “simple things” hospitals can do after something goes wrong.

Final Note: Of course you can (and should) mail a sympathy note or sympathy card, even if you don’t know the family that well.   Just don’t send them marketing magazines proclaiming your latest miracle, invites to the fundraising gala, “satisfaction” surveys, or bills threatening to put them into collections.

- Doug

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

 

Weekend Wrap: Jahi McMath Lawsuit and Sorry Works! Connection (originally posted March 6th)

Many of you will remember the story of Jahi McMath, the young girl who suffered a major adverse event following a tonsillectomy at Children’s Hospital Oakland, was declared brain dead, then her family fought successfully to have her kept on life support and transported to another facility for additional care. Well, some of you may have heard, Jahi’s family filed a lawsuit this week against Children’s Hospital Oakland….a link for a news story about the lawsuit is provided below.

There is an interesting connection between this hospital & case and Sorry Works! — when reading the article linked below you will see at the end of the article a quote from Mr. Wade Westhoff. The Westhoff Family also lost their own daughter after a major adverse event at Children’s Hospital Oakland in January 2013 before the McMath tragedy. The hospital was not empathetic, and did not communicate or stay connected with the Westhoff family post-event. Instead, the hospital mailed multiple marketing and fundraising letters along with a quality survey to the Westhoff’s house! These mailings were a constant reminder of their loss and angered the family. Wade and his wife Jennifer did their own investigation and found several mistakes in their daughter’s care. Wade and Jennifer met with the hospital and offered to reconcile and help fix the post-event communication processes at the hospital. The Westhoff Family also asked that the mailings be stopped. Initially, the hospital was receptive, but, then, the wheels fell off the cart…and the hospital mailings to the Westhoff family continued. Wade warned the hospital they had serious safety problems and the hospital was ill-equipped to communicate with angry, grieving families….then Jahi’s case happened.

Wade and Jen have filed a lawsuit over their own daughter’s case. Sorry Works! did two blog postings on the Westhoff family story, including a letter written by the Wade and Jen about their experiences with Chidlren’s Hospital Oakland. You can find those two articles here and here.

There are many lessons from the Westhoff story, but one of the big and easy take aways is….quit sending mail to folks after an adverse medical event! It incredibly insensitive and can be viewed as abusive, and will increase the anger felt by families. Leadership needs to quickly shut down marketing and fundraising letters; bills need to be put on hold; and surveys stopped. All communications – written, verbal, e-mail, etc — with a family after an adverse event need to be routed through the disclosure team. When I teach disclosure I always drive home this point — because it’s so simple, so necessary, yet so many healthcare organizations miss this point. STOP SENDING MAIL TO TRAUMATIZED FAMILIES!

Here is the link to the article about the Jahi McMath lawsuit which includes the quote from Wade Westhoff.

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Iowa Doctors and Trial Lawyers Working Together on Disclosure & Apology

Hawkeye State physicians and personal injury lawyers are working together to promote disclosure and apology. These long-time adversaries are joined hand-in-hand on legislation in the Iowa capitol that is similar to recently established state-wide programs in Oregon and Massachusetts, including the fact that disclosure-related conversations cannot be shared with regulatory authorities. Significant accomplishment. News article is linked below.

I want to stop right here.

When you think about this story I don’t want you to have visions of your own state capitol, but, instead, think about the lawyers in your own life. The lawyers who represent your organization, and the lawyers who typically sue your facility. If disclosure can bring together the Hatfields and McCoys under the dome of the Iowa capital, why can’t you do the same with the lawyers in your life? Disclosure literally gives you a chance to re-shape the relationship with defense and plaintiff’s counsel, and how these folks work together for the benefit of your clinicians, patients, and families. You don’t have to wait for your state to follow the lead of Iowa, Oregon, and Massachusetts (great if they do), you can do it on your own. Many other hospitals and insurers around the country have already done so, or are doing it right now.

Talk with your defense counsel, bring them on board….a few might need to be re-educated, and one or two may even have to go. Also talk with your local plaintiffs attorneys….talk about how you want to work with them through disclosure and apology. Consider the following quote from Iowa regarding this joint effort by doctors and lawyers:

“Dr. Michael McCoy, a Burlington obstetrician who worked on the proposal, said most doctors want to be honest with their patients. But too often, he said, the doctors are given legal advice not to disclose errors to patients for fear of a lawsuit. ‘Everybody kind of freaks out, and nobody says anything,”‘he said at a House subcommittee meeting. ‘… That system just doesn’t work.’

Brian Galligan, a Des Moines attorney who is president-elect of the lawyers’ group, agreed with McCoy that many patients would be satisfied with the truth, an apology and a plan to prevent errors in the future. Patients are more likely to file lawsuits if they don’t get those things, he said. Their initial goal isn’t to win a big judgment. ‘We often have clients come in and say, ‘I want to know what happened, and I want to make sure this doesn’t happen to anyone else,”’ Galligan said in an interview.”

You don’t need a state-wide push to have these discussions with your lawyers and doctors too. You simply need to establish your own disclosure program. Sorry Works! is here to help. You know, for many organizations the journey to disclosure starts with the Little Book of Empathy and the newly released Pocket Notes. The Little Book of Empathy is great for c-suite, risk, claims, legal, and managers, while Pocket Notes is built for front-line staff. Order your copies here.

Here is the news article about the push by Iowa doctors and trial lawyers.

 

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Weekend Wrap: Jahi McMath Lawsuit and Sorry Works! Connection

Many of you will remember the story of Jahi McMath, the young girl who suffered a major adverse event following a tonsillectomy at Children’s Hospital Oakland, was declared brain dead, then her family fought successfully to have her kept on life support and transported to another facility for additional care. Well, some of you may have heard, Jahi’s family filed a lawsuit this week against Children’s Hospital Oakland….a link for a news story about the lawsuit is provided below.

There is an interesting connection between this hospital & case and Sorry Works! — when reading the article linked below you will see at the end of the article a quote from Mr. Wade Westhoff. The Westhoff Family also lost their own daughter after a major adverse event at Children’s Hospital Oakland in January 2013 before the McMath tragedy. The hospital was not empathetic, and did not communicate or stay connected with the Westhoff family post-event. Instead, the hospital mailed multiple marketing and fundraising letters along with a quality survey to the Westhoff’s house! These mailings were a constant reminder of their loss and angered the family. Wade and his wife Jennifer did their own investigation and found several mistakes in their daughter’s care. Wade and Jennifer met with the hospital and offered to reconcile and help fix the post-event communication processes at the hospital. The Westhoff Family also asked that the mailings be stopped. Initially, the hospital was receptive, but, then, the wheels fell off the cart…and the hospital mailings to the Westhoff family continued. Wade warned the hospital they had serious safety problems and the hospital was ill-equipped to communicate with angry, grieving families….then Jahi’s case happened.

Wade and Jen have filed a lawsuit over their own daughter’s case. Sorry Works! did two blog postings on the Westhoff family story, including a letter written by the Wade and Jen about their experiences with Chidlren’s Hospital Oakland. You can find those two articles here and here.

There are many lessons from the Westhoff story, but one of the big and easy take aways is….quit sending mail to folks after an adverse medical event! It incredibly insensitive and can be viewed as abusive, and will increase the anger felt by families. Leadership needs to quickly shut down marketing and fundraising letters; bills need to be put on hold; and surveys stopped. All communications – written, verbal, e-mail, etc — with a family after an adverse event need to be routed through the disclosure team. When I teach disclosure I always drive home this point — because it’s so simple, so necessary, yet so many healthcare organizations miss this point. STOP SENDING MAIL TO TRAUMATIZED FAMILIES!

Here is the link to the article about the Jahi McMath lawsuit which includes the quote from Wade Westhoff.

Sincerely,

Doug Wojcieszak, Sorry Works! Founder, 618-559-8168, doug@sorryworks.net

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Review of Disclosure Webinar Conducted by The Risk Authority- Stanford University

Last Thursday (Feb.26th) many of our readers enjoyed the disclosure webinar produced by The Risk Authority/Stanford University. The panelists for the webinar were Michelle Mello, JD, PhD, Dr. Tom Gallagher, and Leilani Schweitzer. For those of you who were not able to view the webinar live, a taped version is available by contacting Simon Mawer at smawer@theriskauthority.com.

Lots of good takeaways from the webinar I want to share with the Sorry Works! audience. First, at the beginning, middle, and towards the end of the webinar, the host asked live survey questions of the audience: 1) How many organizations have disclosure programs? 2) What are your attitudes towards disclosure programs? 3) What are the barriers to implementing disclosure programs? I found the results to be interesting and you will too:

How many organizations have disclosure programs?

30% – Full disclosure program operating

30% – Getting a program started

40% – No program

 

What are your attitudes towards disclosure programs?

30% – Fully Committed

55% – Explore/open, OR skeptical

12% – Not sure

 

What are the Barriers to Implementation of Disclosure Programs?

26% – Lack of Leadership

30% – Doctor push back

30% – Lack of know how

14% – Perception that Disclosure Not Needed

 

Michelle Mello shared data on the success of disclosure programs. In addition to the University of Michigan data that many people know about (cutting lawsuits by half, etc), Mello also provided disclosure program data from the University of Illinois Medical Center in Chicago and Stanford Medical Center. UI’s data showed a 50 percent reduction in new claims, and the time to close claims decreased from 55 months to 12 months, while Stanford has seen a 50 percent reduction in lawsuits, indemnity costs reduced by 40 percent, and defense costs reduced by 20 percent.

From the Sorry Works! perspective, when we speak to risk and claims people, they tell us their early data is beginning to mirror the numbers shared by Michelle Mello above. One risk manager summed it up best when she said, “Our claims reduced dramatically when our hospital started running to problems.”

Then, Mello and Gallagher both discussed how healthcare and insurance organizations say they do disclosure, when often they really don’t….which we have also observed at Sorry Works! Some healthcare organizations will “cherry pick” cases, usually the slam dunk cases, but fall back into bad habits with the “gray” or questionable cases. Mello and Gallagher termed this “selective implementation.” Also, leadership of an organization might embrace disclosure, but the front-line staff has not been trained how to communicate with families post-event….so disclosure is not happening as much as it should.  

Gallagher then made an interesting point that resistance to disclosure within any organization will be passive:

“We’re not ready to do disclosure yet”…..”the doctors are still uncomfortable with this idea, we should wait,”…..”Not this case, let’s try with another case,” and so on.

Tom is right….over the last few years of doing disclosure presentations I’ve never had anyone stand up in an audience and say, “We shouldn’t tell the truth to our patients when something goes wrong!”….people would be nuts to utter such words in today’s environment. Yet, after speeches I have had many people say the following: “You know Dr. Smith, the guy on the left hand side with the glasses who was asking all the questions and seemed supportive? Well, he doesn’t think the doctors should be forced to disclose, and doesn’t believe our organization is ready for this…he is our biggest obstacle!”

This issue of passive resistance really speaks to the need for leadership. For disclosure to be successful, you need to have strong leaders who are not afraid to lean on people, change hearts and minds, and, in some instances, remove certain people from the organization. Also, a vibrant, well-thought-out disclosure program will be constantly be sharing information and success stories about disclosure throughout your organization, which, over time, will melt some hardened hearts.

At the end of the webinar, Michelle Mello was asked to give a summary of her feelings and thoughts about disclosure and she had a two word response: “Try it.” People simply need to try disclosure, develop a disclosure program within their organization, and do disclosure with every case. Run to the fire every time!

Again, if you want to see a recording of the webinar, contact The Risk Authority’s Simon Mawer at smawer@theriskauthority.com.

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Consumer Engagement: Residents Hire Staff at Nursing Home

Over the years, I have railed about lack of true consumer engagement within healthcare organizations. I have pushed people to go beyond the “window dressing” of one or two family members on a committee. I have advocated for healthcare organizations and insurers to interview patients and families post-event to add credibility to the review process and subsequent disclosure conversations. And I have shared stories of patients/families getting involved with healthcare organizations in a meaningful way after adverse events with Grand Rounds presentations, being involved in the safety fixes, and even consulting.

Then, there was this story that was recently circulated on Facebook by Martine Ehrenclou. One Illinois nursing home is actually letting residents have the final say on applicants for staff positions. The home’s leadership conducts the initial vetting of applications and does the first round interviews, but the residents give the final thumbs up or thumbs down….and apparently the residents have given the kibosh to several would-be staff members. Wow! Talk about empowerment, and talk about a great way to strengthen relationships and trust. That’s the kind of relationship that can withstand adverse events so long as effective disclosure is part of the picture.

How could acute care organizations follow this example?

Hey, remember, tomorrow — Feb 26th – the Risk Authority-Stanford is holding their FREE webinar with three big-time disclosure rock stars: Michelle Mello, Dr. Tom Gallagher, and Leilani Schweitzer. You will learn a lot from Michelle, Tom, and Leilani. Here is the link to register for this free webinar.

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The Risk Authority-Stanford Holding Free Disclosure Webinar with Three Rock Stars

Last week I was contacted by the good folks at the Risk Authority-Stanford to help promote their upcoming FREE February 26th webinar with three big-time rock stars: Michelle Mello, Dr. Tom Gallagher, and Leilani Schweitzer. You will learn a lot from Michelle, Tom, and Leilani. Here is the link to register for this free webinar, and below is the text from Stanford’s marketing materials.

Best,

- Doug

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

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

Title: Communication and Resolution Programs: Voices of Experience

Date: Thursday, February 26, 2015

Time: 11:00 AM Pacific Standard Time

Duration: 1 hour

Format: Live panel discussion delivered by video webcast with Michelle Mello, Dr. Tom Gallagher, and Leilani Schweitzer

 

Title

Communication and Resolution Programs:

Voices of Experience.

 

Summary

Communication and Resolution Programs (CRPs) promise to reduce liability costs, promote a culture of safety and provide a vehicle for disclosure and healing between providers and patients after a medical error. Over the past decade, several CRPs have been pioneered and studied at leading medical centers.

In this live webcast event, we bring together three leading voices in the field – a health law scholar, a physician and a patient, to discuss:

  • Have CRPs delievered on their promise? What do the data show?
  • What best practices have emerged?
  • What challenges need to be overcome?
  • What resources are available to institutions interested in exploring or strengthening CRPs?

The Risk Authority – Stanford, in partnership with Aon Risk Solutions, Lockton Health Risk Solutions and The Medical Protective Company invite you to participate in this important event and gain insights and solutions into the critical aspects of communication and resolution programs.

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