Hospitals and Disaster Plans
Last summer I heard Jim Conway of IHI give a presentation on handling adverse events, and he made an interesting comment I’ve never forgotten: Most hospitals have detailed response plans for fires, hurricanes, tornadoes, and terrorist attacks (truly rare events), but few have detailed plans for handling adverse events and medical errors (all too common events). In a follow up e-mail, Mr. Conway wrote 75% or more of hospitals DON’T have plans for dealing with adverse events, and among those facilities with plans, the plans are not often used when events occur. It’s been our experience at Sorry Works! that many hospitals and healthcare organizations have disclosure policies, but these policies certainly are NOT plans. Furthermore, even when leadership embraces disclosure, the front-line clinicians and staff often have no idea what to do when events occur and are still fearful of “sorry” and other aspects of disclosure. Many front-line people have yet to receive adequate training or education on disclosure, and many do not know support is available for them during and after an event. They feel isolated and know they are uneducated on this topic, which leads to fear and silence when something does go wrong. But, God love’em, they know what to do should a tornado hit the hospital!
You have to think back to really remember a hospital that was hit with a major storm, fire, or terrorist attack. Last prominent story I can remember is the hospitals in the path of Katrina – yet we hear and read about medical errors almost every day.
Here’s another angle: I was recently talking with an attorney who witnessed a commercial airplane crash up close. The attorney told me the airline’s crisis team snapped into action. Team members were assigned families, met with them, cried with them, and did what these people needed quickly with no hassles. The crisis team members had check books in their back pockets to cover food, lodging, transportation, and other costs…no red tape, no “we’ll get back to you,” etc. Problems solved, immediately. The attorney said the airline was still expecting to get sued, but the actions of their crisis team would take some of the sting out of the case and show the airline truly cared and had concern for the families. Bottom line is the crisis team members had a plan and were trained to carry out the plan.
Does your hospital have a similar team of people in place to deal with grieving patients and families? Are these people empowered and given the tools to do the job right, quickly? Are they educated on the art and science of delivering bad news and dealing with grief stricken, angry people? If not, why?
Jim Conway and IHI developed a white paper on the subject titled “Respectful Management of Serious Adverse Clinical Events,” which is available on the IHI website. Below is some great data about the paper’s acceptance shared by Jim Conway:
– As of today, after 5 months, approximately 25,000 people have visited the landing page and 8,000 have downloaded the report from this one location.
– An article on the report in Healthcare Executive (journal of the ACHE) had 1,000 downloads from the IHI.org site alone
– Organizations, systems, captives, and countries are evaluating comprehensive implementation of recommendations.
– Organizations are using the White Paper to help guide the management of serious adverse events and telling us about their experience.
– Content has be integrated into IHI training programs for Boards, Executive Leaders, Patient Safety Officers, and more with considerable interest. A Learning Lab at the IHI Forum was very well received.
– Efforts are underway to increase awareness of the report within the risk management, quality improvement, legal, public relations, and other communities.
– IHI discussions groups are seeing increased uptake; I continued to be fascinated at the large number of people who look at the posts and DON?T comment.
– Another WIHI on the topic is being scheduled for the spring.
This is a great response, and shows how people are literally thirsting for knowledge and information on this subject. I think the debate surrounding disclosure – should we do it or not? – is over. People know disclosure is necessary for numerous reasons….the trick is how do you do it? This paper helps. Our Sorry Works! Book http://www.sorryworks.net/booksoon.phtml has also helped thousands understand and embrace disclosure for their hospitals, insurance companies, and practices.
Conclusion: You know you need a disclosure plan and trained & empowered people ready to carry out the plan – and there are solid resources avaialable to help you achieve these goals.