Identifying Team Members? --- Reflections on Disclosure Policies
|A few weeks ago I wrote the original post below, and many people read this e-newsletter and shared with colleagues. I want to add to this discussion by reflecting on the "Don'ts sections" found in most disclosure policies, especially as it relates to identifying team members or colleagues.
Most disclosure policies have don'ts sections which cover stuff like "Don't speculate" or "Don't assign blame," all of which I agree with. However, here is a typical "Don't" I struggle with: "Don't identify colleagues involved in the adverse event to the patient or family." Now, I understand why a defense lawyer or risk manager may want to write this statement into a disclosure policy, but consider the following questions from patients and families:
"What were the names of the doctors and nurses involved in my son's surgery?"
"What was the name of that doctor who visited me yesterday afternoon? You know, the tall one with the accent?"
What was the name of those two nurses last night? You know, the two idiots who could never answer my call button. I think they were goofing off all the time..."
If you follow your policy to the letter how do you NOT answer these inquiries and NOT look/sound like cover up is starting? How do you NOT start breaking trust with patients and families? You can't. Look, sharing the names of people involved in an event or situation does NOT mean we are assigning blame or implying they are bad clinicians. Again, no speculating or jousting, even if you have a hunch a mistake did happen. Simply stick with what you know:
"Yes, the tall physician with the accent is Dr. Smith."
"The nurses who cared for you last night were Ms. Jacobs and Mr. Jones. I am sorry you were frustrated. I suggest you speak with Jacobs and Jones this evening, and/or speak with the nursing manager."
In disclosure we always say staying connected post-event is the best thing for patients, families, and caregivers. Sometimes, these folks simply need to get connected in the first place, which means providing a name.
Hey, remember, summer is coming to a close, and Sorry Works! makes a great presentation for your Grand Rounds and other staff educational events. To schedule a Sorry Works! presentation for Fall 2013 and Winter/Spring 2014, call 618-559-8168 or e-mail email@example.com.
Doug Wojcieszak, Founder, Sorry Works!
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!
For help developing your disclosure program, be sure to contact Sorry Works! at 618-559-8168 or firstname.lastname@example.org.
Doug Wojcieszak Founder Sorry Works! PO Box 531 Glen Carbon, IL 62034 618-559-8168