Reflections on Disclosure Policies....
I recently gave a presentation for a large hospital system, and whenever I give a speech I am always happy to customize my talk for the host. Well, this hospital wanted me to incorporate their disclosure policy into my presentation, and I did so by asking the following question at the beginning of the talk: "Doctors and nurses, how many of you know this disclosure policy exists (holding up a copy of the disclosure policy in my hands)?" Out of an audience 70 to 80 caregivers, three or four hands went up. Then another question: "How many of you have read the disclosure policy?" Two hands up.
Pretty startling. However, I don't think was an indictment of this one hospital, as I imagine I would get the same response at any hospital. Sure, we've had disclosure policies on the books at most American hospitals since 2001 because JCAHO made it a requirement, but these policies have been little more than another checkmark on the way to meeting JCAHO requirements. Now, to be fair, with disclosure gaining in popularity many hospitals are revisiting their disclosure policies and trying to be very thoughtful with these documents. And I've been asked to review several of these policies, and what strikes me is how these documents can't be very helpful for front-line staff trying to figure out disclosure. No, disclosure policies usually read like legal documents, which is no surprise because they are mostly written by lawyers. These bland, legal organs full of lengthy definitions often provide no practical, real-world advice for the physician or nurse who is dealing with an adverse event at 2am on a Saturday morning (because that's when most events happen!).
For example, disclosure policies often state some version of the following: "Provide empathetic gestures post-event to the patient or family without speculating or assigning blame." I agree but, what exactly does that mean? What does that look and sound like? Can you give me an example?
Look, having a disclosure policy is a good thing, but, let's make these documents more practical, and make sure the docs and nurses know the policy exists and have read it. We know the empathy and apology reduce litigation, so the disclosure policy should be a BIG deal. Make it good reading and make sure people read it. The disclosure policy should be part of your orientation for new hires, and do in-service programs for existing staff. And, more importantly, let's provide the training and support necessary for our docs and nurses to live the disclosure policy. What I am talking about is developing a disclosure program within your hospital, practice, or insurance company. A disclosure policy is not enough...you need a disclosure program. Want your staff to live your disclosure policy and reduce litigation? You need a disclosure program!
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