Question from Road: Who's Paying?!?
QUESTION FROM THE ROAD: WHO'S PAYING?!?
Back in November I was involved in the kick-off of a disclosure training program at a large Midwestern hospital. The hospital was training their disclosure team leaders, and I was happy and proud to be involved in this effort. The evening program consisted of a few short presentations, followed by a series of disclosure scenarios with actors playing the roles of patients, family members, and other clinicians. The actors were excellent. Very real. Team leaders had to disclose and communicate with all the different stake holders. In one exam room, four actors played the roles of a father, mother, step-mother, and grandmother of the hypothetical thirty-year old woman who suffered a serious event just prior to discharge. They played their roles perfectly, including the father who kept excitedly asking/demanding: "Who's going to pay for all this additional medical treatment?!? Who's gonna pay?!!" I wanna know! We can't afford it!!!
And that's this week's question from the road.
How do you answer this question? It's a tough spot. Say "yes" and you might be committing your organization to a mountain of bills and/or you might later have to recant on that promise and kill the relationship with the patient or family. Say "no" and you might kill the relationship right there and then and get ready for the lawsuit. What do you do?
I suspect caregivers often face this question in the immediate after-math of events, but even more so now because of the tough economic climate. What do you do??
Again, we come back to our message of empathy without prematurely admitting fault. Part of that empathy is being pro-active without promising things you can't deliver on because you put everyone in an impossible situation, including the patient and family. With the facts I've given in this situation, you know there is a patient who was getting ready to be discharged but suffered a serious advent and the family is very upset....they feel like the rug has been pulled out from under them. They were getting ready to go home, but now their loved is in danger and the meter is running again. But that's all you know.
So here's my thoughts....you say "sorry this happened, and we need to understand what happened and why it happened." You acknowledge their fears and concerns about medical bills - "I understand you are concerned about the additional care your daughter is going to need and how that care is going to be paid for" - and promise you and the organization will discuss this issue when you understand all the facts about what happened....but then quickly emphasize the important thing right now is taking care of the daughter's medical needs, and helping the family anyway you can now. You offer immediate assistance with food, transportation, lodging, phone calls, and other service issues.
Remember, any disclosure program empowers their front-line staff up to a certain dollar level to take care of the "little things" quickly and immediately without seeking prior approval. Then, before concluding the meeting, you commit to a date/time to meet again. "Let's plan to meet again tomorrow afternoon at 3pm to discuss the latest information, however, here is my business card...you are welcome to call my cell phone anytime. If for some reason I don't answer, please leave a message and I will call you back as soon as possible. OK?"
During the investigation, plan to contact the patient/family at least once a week via phone or e-mail, and document your communication efforts. Don't let communication or the relationship fall off during the investigative phase, lest the family build relationships with other people, such as a lawyer, state regulator, or the media.
If the investigation proves an error that caused harm and led to additional hospitalization, then you will be waving bills (as well as possibly providing additional compensation, both monetary and non- monetary). If no error, then you need to make a decision about billing the patient/family, reducing the bill, or simply writing it off. Every situation is different. If you do feel a bill is appropriate, be sure to communicate with the patient or family before the bill is sent and explain your reasoning. A unexplained bill showing up in the mail can take the roof out of the house and literally push people to a lawyer.
Empathy is about staying connected and rebuilding relationships with patients and families. A pointed question such as this actually helps provide a road map of what is important and what you need to keep in mind as you empathize.
For more information on disclosure training with Sorry Works! including instruction on empathy, be sure to call 618-559-8168 or e- mail firstname.lastname@example.org. Also, be sure get yourself a copy of our new "Little Book of Empathy." Click here to order: https://secureserv er.wildfire.net/sorryworks/.
Doug Wojcieszak, Founder Sorry Works! PO Box 531 Glen Carbon, IL 62034 618-559-8168 (direct dial)