Training Away Inappropriate Comments from Front-Line Staff

There was a blog post published a physician this week discussing the need for honesty, candor, and restitution post-event.  The physician did caution her colleagues that not every adverse event is a compensable error.  What really caught my eye, however, was the physician author's legitimate complaints about off-the-cuff remarks made by staff to families: "Oh, your husband's cancer should have been caught earlier, and he wouldn't be dying in hospice right now."   These ill-informed comments can literally trap people in the grief cycle.  We wrote about the very real phenomenon of frozen grief due to no disclosure a few weeks ago.  Well, people can become frozen in grief by inappropriate disclosure too.

I understand why some staff feel compelled to utter these comments...they legitimately believe that patients/families will have no other way to learn the truth; their conscience literally forces them to make these remarks.  Indeed, in the days of deny and defend, patients and families would often only learn about a potential error via a hushed conversation with a nurse, or through their own intuition. However, disclosure has become more prevalent, and we need staff to adjust.  Part of developing a good disclosure program is sharing the good news with staff, and not only empowering them to be empathetic and stay connected post-event, but also help them to realize that families will receive the complete truth when all the facts are known.  Flippant remarks are not helpful. 

I believe it's important for staff to understand the potential consequences of making uneducated comments to patients and families.  Not only can flippant remarks potentially put colleagues in hot water, but it can also raise unfounded questions and doubts with families, and, again, interrupt and even permanently impair the grieving process. "But, that nurse said an error killed Daddy, but every lawyer turns down our case...I don't understand."  This can lead to frozen/permanent grief. 

Now, please, I am not talking about situations involving clear/known errors.  What I am discussing is the scenario reviewed bythe physician author in her blog post: Wife is understandably upset that her husband is in hospice with terminal cancer, but a nurse flippantly states the doctors should have diagnosed the cancer earlier and the man could have been cured!  Now is that the truth?  Maybe....maybe not.  But, it's a heck of a statement at a very delicate time. If your healthcare organization has a disclosure program and staff are truly trained, they would know to first share concerns/questions with leadership prior to blurting out unfiltered thoughts to a patient or family.  Moreover, staff would know if confronted by an angry/questioning family member, to refer the family member back to the physician in charge of the care (and possibly give the family member some suggested questions to ask).

One of the common slogans in disclosure is say what you know, when you know it.  We work hard to deal in facts, not opinion and conjecture. It's totally OK to say "I don't know" and then work hard to find the answer while staying connected with the patient/family.  Never cover up the truth, but only speak what you absolutely know to be the truth.   

Look, for years, we've had the exact opposite problem: Nobody would say anything post-event, even with instances of clear error.  Now we have a lot more people talking, but some are not presenting facts.  We need to find the happy medium. 

Be sure to visit the Sorry Works! store....lots of great items, including the Sorry Works! Tool Kit and the Little Book of Empathy.  

Sincerely,

- Doug

Doug Wojcieszak, 618-559-8168