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Sorry Works! Blog

Making Disclosure A Reality For Healthcare Organizations 

Two New Studies on Disclosure and Apology

Welcome back from Thanksgiving Break! Hopefully everyone had a restful holiday. Two new studies were recently covered by trade publications. One study says that only 11% of patients/families who experience harm receive an apology from a healthcare organization. This study was based off a survey administered by ProPublica, and while I don't doubt that most consumers still do not receive apologies, I really question the efficacy and strength of a survey conducted by ProPublica on this subject. I'll leave it at that...

The second study was more of a ethical discussion about disclosure in the Journal Pediatrics. The authors presented the following case in their paper which the trade media picked up on:

"A four month old, former 23 week preemie; several weeks of high-frequency oscillating ventilation and vasopressor infusions; multiple operations for complications of necrotizing enterocolitis; docs suggested, but mother refused DNR. Following slight improvement, condition worsened. Evaluated for sepsis, started antibiotics, back on ventilation. Baby went into cardiac arrest.

A radiologist noted, on a chest radiograph taken during the resuscitation, that SP's central line was in her aorta and not in a central vein as it should have been....[Baby's] decline over the past several days and her cardiac arrest were likely the result of arterial emboli from her central line and the administration of medications directly into her arterial system....consistent with severe hypoxic ischemic injury.

Should the docs have recommended the DNR? And how much should they tell the mother about the misplaced line?"

So, how would you and your clinicians handle this type of case? What would you say, and not say? Who would do the talking, where, and when? And lots of other questions....

When teaching disclosure to clinicians, I present them with cases such as the one above and I find there is a still a lot of hesitancy to respond to the cases in any fashion. It's often stony silence, uncomfortable eye contact, papers being shuffled, etc. Clinicians are not sure how and when to address the clinical aspects of the case, and often have no idea (or appreciation) for how to handle the emotional aspects of the case. So, we get lots of silence, and consumers feeling like they are being abandoned by their doctors and nurses which can increase the chances for litigation and other forms of revenge.

At Sorry Works!, we teach in the immediate aftermath of an event to first address the emotional aspects of the case because the medicine or science has failed us (error or no error). We tell docs and nurses to literally become impromptu grief counselors, and show them how to do it. How to be a presence for a family that is hurting. Moreover, we tell docs and nurses that no one is really ready to talk about the specifics of a case in the immediate aftermath of an event. Docs and nurses often don't have the facts together or they are acting on hunches, and the family is not really ready to listen and process, even if they are demanding answers. Instead, stick to empathy and address emotional needs as well as customer service necessities (food, lodging, transportation, minister, etc)...plenty of time down the road to discuss the scientific stuff. We also talk about the importance of not getting stuck in circular conversations or debates with patients and families, but needing to keep open the lines of communication and maintain the relationship with your customers.

Unfortunately, too many clinicians have not received this simple training and they continue to struggle with post-event discussions. We know finances are tight in healthcare and schedules are jam-packed, but if you stop just one lawsuit, then disclosure training pays for itself. Literally.

As we close out 2014, let's make disclosure more of a priority for 2015 so that the next time ProPublica or some other group conducts a survey they receive a much different response about apology. Lots of work to do but it's worth the investment.

Here is the link for the ProPublica based study, and here is the link for the article on the Pediatrics study.

Welcome back from Thanksgiving Break! Hopefully everyone had a restful holiday.

Two new studies were recently covered by trade publications. One study says that only 11% of patients/families who experience harm receive an apology from a healthcare organization. This study was based off a survey administered by ProPublica, and while I don't doubt that most consumers still do not receive apologies, I really question the efficacy and strength of a survey conducted by ProPublica on this subject. I'll leave it at that...

The second study was more of a ethical discussion about disclosure in the Journal Pediatrics. The authors presented the following case in their paper which the trade media picked up on:

"A four month old, former 23 week preemie; several weeks of high-frequency oscillating ventilation and vasopressor infusions; multiple operations for complications of necrotizing enterocolitis; docs suggested, but mother refused DNR. Following slight improvement, condition worsened. Evaluated for sepsis, started antibiotics, back on ventilation. Baby went into cardiac arrest.

A radiologist noted, on a chest radiograph taken during the resuscitation, that SP's central line was in her aorta and not in a central vein as it should have been....[Baby's] decline over the past several days and her cardiac arrest were likely the result of arterial emboli from her central line and the administration of medications directly into her arterial system....consistent with severe hypoxic ischemic injury.

Should the docs have recommended the DNR? And how much should they tell the mother about the misplaced line?"

So, how would you and your clinicians handle this type of case? What would you say, and not say? Who would do the talking, where, and when? And lots of other questions....

When teaching disclosure to clinicians, I present them with cases such as the one above and I find there is a still a lot of hesitancy to respond to the cases in any fashion. It's often stony silence, uncomfortable eye contact, papers being shuffled, etc. Clinicians are not sure how and when to address the clinical aspects of the case, and often have no idea (or appreciation) for how to handle the emotional aspects of the case. So, we get lots of silence, and consumers feeling like they are being abandoned by their doctors and nurses which can increase the chances for litigation and other forms of revenge.

At Sorry Works!, we teach in the immediate aftermath of an event to first address the emotional aspects of the case because the medicine or science has failed us (error or no error). We tell docs and nurses to literally become impromptu grief counselors, and show them how to do it. How to be a presence for a family that is hurting. Moreover, we tell docs and nurses that no one is really ready to talk about the specifics of a case in the immediate aftermath of an event. Docs and nurses often don't have the facts together or they are acting on hunches, and the family is not really ready to listen and process, even if they are demanding answers. Instead, stick to empathy and address emotional needs as well as customer service necessities (food, lodging, transportation, minister, etc)...plenty of time down the road to discuss the scientific stuff. We also talk about the importance of not getting stuck in circular conversations or debates with patients and families, but needing to keep open the lines of communication and maintain the relationship with your customers.

Unfortunately, too many clinicians have not received this simple training and they continue to struggle with post-event discussions. We know finances are tight in healthcare and schedules are jam-packed, but if you stop just one lawsuit, then disclosure training pays for itself. Literally.

As we close out 2014, let's make disclosure more of a priority for 2015 so that the next time ProPublica or some other group conducts a survey they receive a much different response about apology. Lots of work to do but it's worth the investment.

Here is the link for the ProPublica based study, and here is the link for the article on the Pediatrics study.

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