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Compensation Following Apology: IHI White Paper

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July 7, 2011 Doug Wojcieszak, Founder Contact phone/e-mail address: 618-559-8168;

COMPENSATION FOLLOWING APOLOGY - IHI WHITE PAPER Last year Jim Conway of IHI published an important white paper on the management of adverse events, which included a heavy emphasis on communicating with patients/families and meeting their needs. It's an excellent paper that was very well received.

Jim and the IHI team are updating the paper and they are seeking input. Jim recently sent an e-mail to a large group of people - including me - and several comments followed. The comments of disclosure pioneers Steve Kraman, MD, Rick Boothman, Esq, and Lucian Leape, MD on the need for more emphasis on adequate compensation following apologies caught my attention, and I responded (see my comments below).

Fair and just compensation (financial as well as non-financial) is the critical closing piece of any disclosure process, yet, many hospitals, insurers, and practices don't adequately think about or prepare the compensation component of their disclosure programs. As I write below, many disclosure policies have no mention of compensation. Clearly, we need to make fair & just compensation a priority in the disclosure movement.

Apologies without compensation are often hollow and meaningless. Critics will say, "It's always about the damm money," but, who are we kidding? Patients and families need to be fairly reimbursed for lost time, expenses, pain & suffering, and, yes, crippling injuries or even death. However, we always tell people when you apologize the money stuff gets a lot less scary because anger is dissipated and you can have a rationale, adult discussion with patients and/or families to learn their needs --- and sometimes it has nothing to do with money!!

Anyway, my comments are below followed by Jim Conway's original e- mail asking for help in the update of the IHI white paper on adverse events.


- Doug

Doug Wojcieszak, Founder Sorry Works! PO Box 531 Glen Carbon, IL 62034 618-559-8168 (direct dial)

Wojcieszak comments Dear Jim, I want to echo/add to the comments of Rick Boothman, Esq, Dr. Steve Kraman, and Dr. Lucian Leape:

1) The compensation piece: I think many, many hospitals, practices, and insurers struggle with this piece. I've read countless disclosure policies and seen no mention of compensation, and it makes me wonder. From the patient/family perspective, is the organization hoping that a little empathy and customer service will placate me? I'm sure some of this behavior is going on, and it's not good for patient & families but it's also not good for hospitals, insurers, and their disclosure efforts BECAUSE disclosure programs will fail if they are not credible to all parties, including PI attorneys. Providing fair compensation is part of the healing and closure process for all parties, including the staff. And the best thing is after the apology you have a better chance of learning the real needs of a patient or family - and it may have nothing to do with money! The compensation piece needs to be discussed much more in the disclosure movement.

2) The empathy piece: I want to add our observations and experiences. We are focusing heavily on teaching front-line staff the importance of empathy and good customer service in the immediate aftermath of an adverse event WITHOUT admitting fault EVEN if they think a mistake occurred....because as Rick wrote the snap disclosure of "we made a mistake" may not match with the investigation and now you've got a huge problem.

A big part of teaching the empathy content is showing the difference between empathy and apology. "I'm sorry this happened...I feel bad for you" being empathy, and "I'm sorry we screwed up" is apology. Staff need to understand this difference, and when they do it empowers them to stay connected to patients and families post-event without pre-maturely admitting fault and doing damage to everyone, including the patients and families.

We say be quick to empathize and serve, but PAUSE before apologizing.

Last point on empathy: I hear/see a lot of organizations that say they are "disclosure" and apologize for their mistakes, etc, but if you talk to their front-line docs, nurses, and other staff as well as risk and legal, these folks have no idea what the leadership is talking about.....all these folks typically know how to do is shut up after an event, because that is what they've been told to do for decades! They need training. They need to be taught and have the disclosure message driven home. Stressing empathy and customer service while giving a glimpse into the bigger picture of disclosure (including what the apology/compensation piece looks like) is a good way to help these folks.

Thanks for listening....


- Doug

Doug Wojcieszak, Founder, Sorry Works!, 618-559-8168

Subject: Updates Requested: Respectful Management of Serious Clinical

Greetings all. Your help is needed. In October of 2010 IHI was excited to release this White Paper at the National Association for Healthcare Quality Annual Meeting (NAHQ) in partnership with an amazing community. Since that time:

* over 30,000 people have visited the landing page for it, * more than 10,000 have downloaded it, * presentations have been given around the world, * we've received a number of powerful stories about its use, and * many of you have been kind enough to send in suggestions for improvement.

This October, 2011 I'm thrilled to be discussing the content at the American Society of Healthcare Risk Management Annual Meeting (ASHRM). In line with that presentation, we are planning to do appropriate updates. So, here is the ask:

* Any suggestions you have for updates to the White Paper content, check lists, citations, resources? * Any stories you want to tell (attributed or blinded) on how the paper has been used? * Any recommendations you have for improvement? * Any thoughts on the largest challenges that remain for you, your organization, and/or the field?

The strength of the White Paper and recommendations is the amazing community that has come together around it. We thank you all for that and look forward to your further contributions.

Best wishes, Jim

Hyperlink to White Paper and resources:

Adverse Events White Paper