New Disclosure & Apology Study in Health Affairs

Yesterday, I received an e-mail from Dr. Michelle Mello of the Harvard Public School Health concerning a new study on disclosure and apology in the December issue of Health Affairs authored by her, Dr. Thomas Gallagher, and others.   To obtain a copy of the study, contact Dr. Mello directly at mmello@hsph.harvard.edu. Below are excerpts from Michelle's e-mail to me and others.   I still need to read the article, but I wanted to get this out quickly to our readership.  It sounds like this study will add to the growing discussion concerning the need to fairly compensate when apologizing for true medical errors.

Also interesting is the author's suggestion to keep doctors out of compensation discussions, so it doesn't appear that docs are apologizing and offering money to simply avoid a lawsuit.  This is an interesting point.   I know some hospitals/insurers already keep docs out of compensation discussions, while others involve them.   Earlier this year we wrote about the importance of including caregivers in the conclusion of cases because a) they know the patient/family best, and b) doctors and nurses need to know and understand how cases are closed...so often they don't know.   We wrote that sometimes the emotional/non-financial needs can be the most important element in closure of cases, and caregivers' participation can be important when trying to meet emotional/non-financial needs.  What do others think?

Finally, the author's suggestion to help patients and families connect with "capable, experienced legal counsel" to review offers of compensation is noteworthy.  On this front, Sorry Works! will have a major announcement next week --- stay tuned!

Study Reveals Complexities of Disclosing and Compensating for Medical Mistakes

When disclosing a medical error to patients, healthcare providers should follow up with a proactive offer of compensation—but patients’ responses may not be as straightforward as they might expect.  According to a study by Harvard School of Public Health (HSPH) researchers and colleagues, two thirds of patients expect compensation following a harmful medical error, and three quarters are likely to accept even modest compensation offers.  But offering full compensation can prompt suspicion that the provider is motivated by a desire to avoid a lawsuit, rather than a desire to do the right thing.  To preserve trust in physicians, the authors recommend clearly separating disclosure and compensation discussions and leaving physicians out of talks about money.

What did this study find?

·        Two thirds of U.S. adults feel that they should be offered compensation following a medical error.

·        Patients are likely to accept even relatively modest offers of compensation, like offers to waive medical bills (70% likely to accept) or reimburse a limited amount of out-of-pocket expenses related (79% likely to accept).

·        Patients are about half as likely to accept an offer of full compensation that requires them to waive their right to sue than to accept more modest offers that don’t require them to give up any rights.

·        Increasing the amount of the compensation offer doesn’t decrease the likelihood that people will want to consult an attorney about whether to take it.  Injury severity is the biggest predictor of wanting to seek legal advice.

·        People who believe the provider is offering compensation primarily to avoid a lawsuit are half as likely to accept the offer as people who believe the provider has a less self-interested motive.  The more money is offered, the more likely people are to perceive a self-interested motive for both offering compensation and admitting the error.

Why is this study important?

There is broad interest nationwide in “disclosure-and-resolution” programs, in which hospitals and their malpractice insurers disclose adverse events to affected patients and their families; apologize; and, where appropriate, offer compensation without waiting for the patient to sue.  Pioneers of this approach report success in reducing liability costs and improving patients’ experience following a medical injury, but can’t tell how much of the benefit is attributable to being honest about errors and apologizing, versus offering compensation.

What should hospitals and malpractice insurers consider doing, based on these findings?

·        Disclosures and apologies for errors should be accompanied by fair offers of compensation. Admitting errors and apologizing, while very important, won’t meet the needs of many patients.

·        To prevent compensation offers from eroding trust in clinical providers, healthcare facilities and their insurers should separate disclosure-and-apology conversations from discussions about compensation.  Physicians shouldn’t be involved in talks about money.

·        Recognizing that many patients will feel the need to have compensation offers evaluated by an attorney—and that attorneys can help patients understand when an offer is indeed fair—insurers should develop resources to help patients connect with capable, experienced legal counsel.