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Sorry Works! Blog

Making Disclosure A Reality For Healthcare Organizations 

Sandbagged by Reporter? -- Baystate Health Story: Disclosure/Apology Programs & the Media

*** Reminder: Sorry Works! Founder Doug Wojcieszak will be at ASHRM this Sunday through Tuesday at Booth #507, which belongs to our partner The Sullivan Group. Sorry Works! and The Sullivan Group will also be making the Industry Spotlight Presentation on Monday from 12:40pm to 1pm PT in Exhibit Hall C. We look forward to seeing you at ASHRM *** Since we published this piece below we've had a few questions about handling reporters. Most notably, people have wondered what to do if sandbagged or surprised by a reporter? People have wondered if Dr. Benjamin, featured in the e-newsletter and article below, was simply surprised by the reporter's questions. Yes, you can be surprised by a reporter, but, here are a few helpful tips for handling this situation like a pro.

Remember, you always control your destiny. If a reporter calls you out of the blue with questions or needs a comment, you don't have to answer on the spot. There is no obligation to do so. If you are not ready to talk, do this instead, "Hi, Mr. Smith, I sure am glad you and The Morning Sentinel are interested in our hospital. I do want to talk with you and answer your questions, but I am running to a meeting right now. What is your story about, and what is your deadline? Either myself or someone else from the organization will call you back."

Now, you or someone else from the organization must call the reporter back, or it will look like a dodge. However, this approach gives you a chance to scout out the reporter and buys you time to collect your thoughts and assemble any documents you might need.

Prepare to talk with a reporter and be the expert. Whenever you have a phone call or meeting scheduled with a reporter, prepare like you would for a job interview. Think of the questions you will be asked, and have documents organized and at your fingertips. Consider looking at previous articles/stories published by the reporter to get a feel for their reporting style, questions they might ask, etc. Be the expert and own your topic. Reporters are usually generalists, and even reporters who specialize in healthcare, insurance, or the legal world don't have time or the resources to know your hospital, practice, etc as well as you.

Do their homework for them. There are two types of reporters: Good ones and lazy ones. Neither has the time or the resources to do the homework, gather documents, etc. Do it for them and you will have great control over what goes in the final article.

OK to say you don't know - but promise to get back to the reporter. Don't ever try to make up something off the cuff. Never get caught in a lie. Being prepared for the basic questions - like tell us a success story with your disclosure program - is a must...this is where Dr. Benjamin got in trouble below. He didn't have a story ready to share, and the reporter spun the situation as a bit of a cover up. However, there may be true curve ball questions that come whistling in from left field. Here's how you handle: "That's a great question, but I don't have an answer at this moment. Let me do some research...when is your deadline so I can get you an answer?" Reporters expect you to answer basic questions during an interview, but they will respect you for wanting to do homework on a true curveball (because they hate to be lied to).

OK to follow up after the Interview:  You do the interview, you feel good, but on the car ride home you think, "Boy, I should have said X, or I wish I had brought up Y during the interview."  What do you do?  Give the reporter a call.  Reporters appreciate people who are conscientious.  "Mr. Smith, I was thinking more about our interview, and I want to add to my answer concerning X...."

Question: But, Doug, what if a reporter really sandbags you? If they literally come jumping out the bushes as you walk to your car and slam with you the following question: "Dr. Jones, I'm Scoop Fredericks from Action 5 News, and two of your former nurses have told us that Memorial Hospital has killed 100 patients over the last two years, and you and your defense lawyer personally have covered up every one of these cases. Can you give us a comment?"

Most people when confronted in this manner will run away, jump in the car, and maybe even give the reporter or cameraman a shove. Don't do this....because on the six o'clock news they will spin it as you are covering up the truth and everyone including your dog will hate you. Do this instead:

"Hi, Scoop, I am happy to talk with you...please tell your cameraman to stop recording and we will walk back to my office where we can have a discussion."

Totally disarming. If Scoop keeps filming, he looks like a jerk. If Scoops tell the cameraman to shut it down, this means you are in charge (which you are.) Scoop and you walk back to the office, talk off the record for a while, and when you are ready to make a statement you tell ol' Scoop it is OK for the cameraman to record again.

Sincerely,

- Doug

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

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Original e-newsletter from last week concerning the Baystate Health Story

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.'"

Ouch!

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.

Sincerely,

- Doug

Doug Wojcieszak, Founder

Sorry Works!, 618-559-8168

 

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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.

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