Rethinking Disclosure & Apology: Should Programs Be The Emphasis?
Through the years, I have always emphasized the need for disclosure "programs," or disclosure and apology programs. Others have given the same advice, from the University of Michigan ("Michigan Model") and the University of Illinois Medical Center/Medstar Folks ("CANDOR) to the Collaborative (Communication and Resolution Programs or CRPs). Development of these programs requires a lot of planning and resources, including trained and committed people, to establish and sustain them. However, in the realm of disclosure, I have never been able to get my mind around one big problem in healthcare: Turnover.
To know healthcare is to know turnover. Lots of it. Turnover in not just the front-line staff, but also the mid-level managers and on up, especially the C-suite. In reviewing the hundreds of hospitals and nursing homes I have worked with over the years, I don't know many people who are still around. Many have moved on, moved up, retired, or (sadly) died. You can have the most beautiful disclosure program going with all the right people in the right places, everyone is trained, and everyone knows what to do when something goes wrong...but then folks leave. More leave, and before long the "program" is no longer because the new hires came in the door with different training, different priorities, and different values.
I am wondering if the disclosure movement needs to refocus/reprioritize our efforts in medical, nursing, law, and business schools? Of course, don't give up on our current crop of healthcare professionals, but to make long-term, lasting change in this field do we need to focus our resources on the schools that are producing the next crop of healthcare professionals? So that when turnover happens at your hospital or nursing home, it's no big deal...because the next person walking in the door has been taught the same stuff about disclosure as the person who just left. The next man or woman up knows how to do disclosure because it was required in school and the curriculum was the same at all of our schools.
Hopefully this column starts a discussion in the disclosure movement.
Sincerely,
- Doug
Doug Wojcieszak, MA, MS
Founder & President
Sorry Works
618-559-8168 (direct dial)