Baystate Health Story: Disclosure/Apology Programs & the Media
Below is a story about disclosure at Boston-area hospitals. The reporter interviewed Dr. Evan Benjamin who is the leader of the Baystate Health disclosure program. It's a pretty good article....Dr. Benjamin said his disclosure program had reviewed 100 cases and decided six cases warranted a full apology. However, unfortunately, Dr. Benjamin was not ready to answer certain questions about his disclosure program. Consider the following section from the article: "Benjamin, though, was not prepared to be completely transparent in our interview. He would not say how many resolutions included money, nor the amounts, which are paid by the hospital's insurance -- a Baystate-owned company. The hospital also declined to give out contact information for any patients or doctors involved in an error. And Benjamin said he couldn't remember any case details.
I'd have to pull up my data,' he said during the interview. 'I'm not prepared to do that.... I'd have to get my staff to pull those particular cases.'"
First rule of dealing with the media is they like stories. Reporters are basically story tellers, and they often want more than facts, figures, and charts. Don't tell us about how you operate a dog rescue agency that saved 1,000 dogs over the last five years, no, show us Lassie who you found covered on the side of road with three broken legs, covered with dirt, flees, and ticks, nursed him back to health, and then you found a really nice family to adopt Lassie, etc, etc, then tell us about the 1,000 dogs you saved over the last five years and other great facts and figures about your organization. Understand how the game plays? You give something then you get something.
Second, I understand how 100 cases of care that went wrong might translate into only six cases of apology, meaning a compensable error occurred. Personal injury lawyers will understand this batting average too, as most PI lawyers only accept one case out of 100 that walks in the door. However, the public might not understand, and my gut reaction is the average person who reads this article may be thinking those other 94 cases were just covered up. This needed to be wordsmithed and, yes, spun differently. Consider the following:
"During the life of our disclosure program, we have reviewed 100 different cases where the care did not go as planned. In each of those 100 cases we shared the results of the review with the patient or family. Six of the cases actually involved a medical error, we apologized to the patient or family, and worked to resolve these cases in a fair and just manner."
Here's another a rough area in the news article:
"Benjamin said during our interview he did not know whether families accepting the hospital's resolution must agree not to sue, but a Baystate spokesperson later confirmed that is a condition."
Another rule in dealing with the media is know your facts cold. Be the expert, and part of being the expert is anticipating the questions that will be presented to you and have your answers prepared ahead of time. Otherwise, reporters can become skeptical and think you are not being straight with them.
We have always encouraged you to think of the media (along with regulatory people, PI lawyers, and politicians) as one of the stakeholders in your disclosure program. Don't be afraid to discuss your disclosure program with reporters and also editorial boards. In fact, talking with reporters is one of the ways we educate our patient/family population about our disclosure programs. However, be prepared for interviews and editorial board meetings. Have stories to share and know your facts cold. Don't fly by the seat of your pants.
Lastly, when looking at the article below see at the very end of the piece where the reporter asked two other hospitals how they handle medical errors. One hospital would not discuss their approach, and the other hospital said they wanted to do disclosure & apology but the insurance company said no.
Geez....we have so much work to do! In this vein, Sorry Works! is hosting a "train the "trainer" webinar on November 13th at 1pm ET/10am PT. To learn more and register, click here.
Doug Wojcieszak, Founder
Sorry Works!, 618-559-8168
Hospitals Step Up Apology Process Around Medical Errors
by: Karen Brown, NEPR, October 2, 2014
Massachusetts' Department of Public Health reported 753 cases of serious medical errors at hospitals last year. Patient safety advocates say the best way to reduce medical errors is for hospitals to openly acknowledge mistakes and learn from them. But the fear of malpractice lawsuits has gotten in the way of that. A couple years ago, Massachusetts passed a law that supports a more open apology process. Now, two hospital systems, Baystate Health and Beth Israel Deaconess, are taking that process one step further.
Historically, if a patient was given the wrong medication, or had the wrong leg operated on, or suffered from some other medical misstep, most hospitals would kick into a mode known as 'deny and defend.'
"There was really quiet about what happened," says Dr. Evan Benjamin, who oversees patient safety at Baystate Medical Center in Springfield. "And the only way for patients to get attention around what they believe was a medical error was to sue the organization."
Benjamin says 'deny and defend' rarely gets patients or doctors any closure, and it doesn't make hospitals safer. So he and his colleagues wanted a better approach -- one that addresses what he says patients and their families really want after a medical error.
"They want the truth," he says. "They want to know what happened, and how they're going to be care for. They want an apology,......They want to know what's been learned so it won't happen again. And finally, ...they'd like to understand about compensation for experiencing a medical error."
In 2013, Baystate and Beth Israel launched an effort that Benjamin says offers all those components. The CARe program -- which stands for communication, apology, and resolution -- was modeled after an approach pioneered at the University of Michigan. Over the past 14 months, Benjamin says, Baystate administrators reviewed 100 cases where the care did not go as planned, and decided that 6 of them warranted an apology and resolution. Benjamin says this came after a decade of encouraging doctors and nurses to report their mistakes or near-misses within the hospital.
"Once you have a culture where you're asking people to report errors and being transparent," Benjamin says, "being transparent to patients is the next logical step."
Benjamin, though, was not prepared to be completely transparent in our interview. He would not say how many resolutions included money, nor the amounts, which are paid by the hospital's insurance -- a Baystate-owned company. The hospital also declined to give out contact information for any patients or doctors involved in an error. And Benjamin said he couldn't remember any case details.
"I'd have to pull up my data," he said during the interview. "I'm not prepared to do that.... I'd have to get my staff to pull those particular cases."
But later in the interview, Benjamin did recall one of those cases -- in which an elderly woman's medication was mismanaged after she was transferred to a nursing home. He says, in that case, the family accepted a resolution -- without money.
"It was really about how that family wanted to make sure they were involved in the improvement of when patients are transferred. how can that be improved," he says. "They wanted others to hear what happened. and then we talked about how we could have improved her management as a result of it."
Benjamin said during our interview he did not know whether families accepting the hospital's resolution must agree not to sue, but a Baystate spokesperson later confirmed that is a condition. Some malpractice attorneys have suggested this could put patients in a vulnerable position, but Charlotte Glinka, executive director of the Massachusetts Academy of Trial Attorneys, says she wishes more hospitals had similar apology programs.
"We are obviously very much in favor of doctors being forthcoming with their patients about errors or things that are unexpected," Glinka says.
Glinka's organization worked on the 2012 Massachusetts law that makes most medical apologies inadmissible in court. It also requires a 6 month cooling off period before a patient's family can sue a hospital -- time that can be used to work on a resolution.
"In some instances that's going to make sense for the patient to have an early resolution, to not be involved in a lawsuit that could take 3, 4, 5 years," Glinka says. "But there may be someone who's very severely injured and what the hospital is offering just may not be adequate."
Dr. Benjamin says Baystate patients are encouraged to have a lawyer present during the apology meetings. He says five of the six families approached accepted the hospital's resolution -- and one decided to sue instead. But he says the hospital is not just trying to avoid lawsuits.
"Honestly, the motivation has been to improve patient safety, to do the right thing, by our patients and families," he says.
And to do right by doctors. Benjamin says he cannot point to any specific safety improvements that have come directly out of the CARe program. But he says doctors and administrators are learning how to conduct better apologies.
"A good apology is one from the heart," Benjamin says. "It's an apology for the experience -- an apology that says, 'I made a mistake. We made mistake. We are sorry for that.' As opposed to an apology which is - 'I'm sorry that happened to you.'"
Insurers have done studies that show effective apologies can reduce the number of lawsuits, although Stephanie Sheps of Coverys Insurance -- which supports the CARe approach -- says they still expect to pay the same amount in settlements.
"The real benefit financially comes to the efficiency, of being able to resolve claims more quickly," Sheps says.
Sheps says insurers that used to be skittish about too much disclosure are now embracing apology and resolution programs. That's good news to patient advocates. Paula Griswold of the Massachusetts Coalition for the Prevention of Medical Errors says she's hoping more openness leads to safer hospital practices -- though it may take a while.
"I think what everybody is aiming for is....more reporting of events," Griswold says, "and a greater sense of safety among the clinicians that they won't have their career destroyed."
So far, apology and resolution is not yet standard practice. A Berkshire Medical Center spokesperson says he's never heard of the CARe program, and was not willing to say what kind of approach the hospital takes with medical errors. The patient safety director at Cooley Dickinson Hospital in Northampton says they've moved towards a more open apology process, but as for resolutions offered by the hospital -- he says their insurance company wouldn't allow it.