Interviews with Disclosure and Apology Leaders: Jeff Driver, JD

This year at Sorry Works! we launched a program to interview disclosure and apology leaders and get their perspective on what’s working in the disclosure movement while discussing the challenges we continue to face.  This month we are catching up with Jeff Driver, JD. 

Jeff is familiar to many Sorry Works! readers and followers.  He is a past President of ASHRM and for many years led the pioneering CRP/disclosure program at Stanford Hospitals and the Risk Authority.  Jeff recently retired from full-time risk management work and is now a faculty member at the Edson College of Nursing and Health Innovation at Arizona State University while pursuing a Doctor of Management and PhD at Case Western Reserve University. We greatly appreciate Jeff giving us some of his time for this interview. 
 
SW: Jeff…thank you for doing this interview.  You were a long-time leader with Stanford’s disclosure/CRP program.  What are the two or three of the most important highlights of your time with the Stanford CRP/disclosure program?  What do you want people to know about the Stanford program?

Jeff:  The Stanford CRP program (now known as PEARL: The Process for Early Assessment, Resolution, and Learning) was an early CRP program birthed after the JCAHO issued its disclosure of patient unanticipated outcomes.  At the Risk Authority Stanford, we pioneered several initiatives to improve the CRP approach and customize Stanford’s program.  We tested and applied initiatives to assure to the best of our ability that PEARL operated within the highest ethical principles, as well as adhered to sound policies and practices that promoted fairness and impartiality for all individuals impacted by patient medical injury.  
 
You see, it is my belief (and others) that there is an inherent conflict of interest in the discipline of risk management due to the fiduciary duty of the risk management professional to their organization, employer, or insureds. Now, with that said, I am mindful how the discipline recognizes this conflict and that risk management professionals intend and strive to be advocates for patients, families, and insured hospital staff and physicians. However, we must acknowledge, at the very least, the potential conflict (including unconscious conflict or bias).  At Stanford, we deployed some important and deliberate mechanisms in a move to address and counter the inherent conflict that I speak of.  
 
First, and foremost, we added a patient advocate into the CRP team so that we could truly hear the patient/family voice and challenge ourselves and our thinking with a diversity of perspectives. The second thing our team did, is we marched over to Stanford University to learn and certify in the techniques of quantitative analysis and decision science. From this we developed a risk intelligence team and a procedure to use available data inputs to objectively understand the estimated financial value of a settlement that would occur under PEARL in any given case (just one aspect of managing a CRP case).  These steps were important protective measures in a PEARL due-diligence process, among others, to guide PEARL administrators and inspire others in the CRP community as they move to resolve the compensatory aspects of patient medical injury. 

SW: You recently retired from active risk management and are now a full-time instructor with Edson College of Nursing and Health Innovation at Arizona State University. Tell us about this new role. How are you sharing your lessons and experiences with students at Arizona State University?

Jeff: I have always embraced innovation in healthcare and the management of risk.  We were blessed to test many new ideas and launch risk management innovations at Stanford with the support of senior leaders.  We learned quite a bit along the way, and we were constantly at the edge of risk management innovation with a dream team of talented and passionate risk management professionals.  Arizona State University provides a new home and a new dream team to exercise this innovative spirit and allows me to mentor students and teach progressive aspects of the management of risk in healthcare organizations. For me that means a deeper research dive into organizational responses to patient medical injury, and especially guiding and assisting students in their professional journey and the influence that they will have in the world.  I teach across the innovation and the compliance/regulation and risk management curriculums.  So, while I have ‘retired’ from risk management as a full-time practitioner, I will always be a manger of risk.  But I am among those unsettled sorts who asks a lot of questions about why we do things the way we do things in risk management practice. I’m also asking how we might do better or go to the next level. ASU is a beautiful fit to blend my passions of the management of risk, inquiry, and innovation and my love for mentoring great creative minds. Collected over a 25-year span in the professional risk management space, I have plenty of experiences to share with students, especially those motivated to find better and better ways to help and protect patients in the healthcare setting. I now describe myself as a ‘pracademic,’ with one foot in risk management practice through my consulting work (Soteria Risk Works) and one foot in academia at Case Western Reserve University and Arizona State University. 

SW:  How do nursing students respond to disclosure and apology?  In your opinion, what should every nursing student know about disclosure/CRP?

Jeff: My three-point essential advice for clinical professionals in responding to patient medical injury is to first and foremost attend to their patient needs and their safety, to answer their questions with candor, and to seek help within their organization; not only for the benefit of their patient or their family, but for themselves or others on the clinical team that may be impacted by a patient medical injury. We have come a long way in the disclosure and apology movement in the United States – but we still have much to do.  Some of the barriers to open and honest communications have been mitigated or removed, but others still exist.  But I really think that clinical professionals are much more open to disclosure and apology than ever before, despite some of the continuing barriers. 

SW: You are also currently pursuing a PhD in Management at Case Western Reserve University.  Tell us about your doctoral program, especially the research program you have launched as part of this program.

Jeff:  My inspiration for this pursuit can be traced to a patient who was impacted by a medical injury many, many years ago and a nurse who worked on my team in a risk management role way back in the early nineties.  I met the patient at a conference and her story had stunned me -- even after many years she was not able to reconcile with her medical team and her life had remained terribly impacted, including both the physical and psychological scars of her injury. The nurse, on the other hand, came into my team after she had been directly involved in a medical accident in which the patient lost his life – she was devastated and left the nursing profession. Two tragedies; not only because of the medical injury itself but because of the aftermath. 
After giving CRPs a good think in my studies at Oxford University and reviewing all of the research on them, I decided to focus my research on more fully exploring the concept of  long-term reconciliation – with self and with others – from the perspective of those involved whether patient, family member, physician, nurse, or other clinical professionals.  While this concept of reconciliation has been spoken of in the CRP community and CRP research, I want to understand what this looks like for those that have been impacted by a patient medical injury over the long-term.  I think if we understand the pathway to reconciliation better, we might be able to improve organizational responses to patient medical injury within a holistic and restorative framework for all people involved in a patient medical injury.  In my mind, this research is building toward a sort of CRP Version 2 that moves to facilitate healing and reconciliation in an efficient and effective manner over a lifetime of individual needs.  

What is a bit different about my research is that I am examining long-term reconciliation broadly in patients and families, as well as clinicians that may have been impacted by a patient’s medical injury.  It will be interesting to explore what impacted individual’s reconciliation pathways look like. How are these pathways different? How are they similar? And how might we harness these insights to positively impact healthcare management personnel and organizational responses to patient medical injury?

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We want to thank Jeff for this interview.  We greatly appreciate his time.  If you want to learn more about his research project or if you are interested in being interviewed, please contact Jeff directly at jfd67@case.edu or calling 602-245-1200.