Hospitals often contend that they worry about a greater influx of legal action by patients if they disclose more information when errors occur during care. But studies are starting to show that hospital wariness might be misplaced.
When sorry is enough
Study finds owning up to mistakes better approach
Programs that support greater disclosure and better communication with patients and families are indicating that sharing more information might help lead to a reduced number of malpractice lawsuits, say researchers at the University of Illinois Medical Center at Chicago.
The UIC Institute for Patient Safety Excellence in 2004 implemented a program at the 468-bed medical center that called for providers to follow seven “pillars” of safety, including reporting and investigating events, apologizing to patients and families, identifying areas of improvement and education and collecting data.
In 2006 the program evolved to incorporate full disclosure, which the institute explains is “a process, not an event.” For the year ended July 1, the program resulted in 3,400 incident reports, while over the course of the whole program there have been more than 100 investigations and nearly 200 system improvements. In addition, following the program has led providers to have 106 disclosure conversations and resulted in 35 full disclosures of inappropriate or unreasonable care, according to the institute’s research. Results for the first two years of the full disclosure policy will be published in an upcoming issue of the Quality and Safety in Health Care journal (See chart).
What the institute has found is that patients who are involved and providers who feel safe from retribution through being open tend to bring healing more quickly, said David Mayer, a physician who is associate dean of curriculum and co-directs the UIC institute with Timothy McDonald, a physician who is chief safety and risk officer of health affairs at UIC. Patients “don’t want to be abandoned. They just want to know what happened,” Mayer said.
And despite disclosures, “we have not seen the financial Armageddon that everyone expected to see when you’re open with patients,” McDonald said. “The whole point of this is to learn from our mistakes.”
Learning from mistakes and being open and honest with patients and families have been the goals of safety advocates and providers who have been involved in painful hospital experiences (Nov. 2, p. 6, and Sept. 7, p. 6).
The Chicago team studied a disclosure initiative at the University of Michigan Health System, Ann Arbor, which had developed guidelines on what and how to disclose information and how to balance that against legal admissions of fault. The health system wanted to see whether overcoming the traditional method of “deny and defend” could change the approach to medical malpractice, according to Rick Boothman, chief risk officer for the system. “We realized very early on that there’s complete alignment between patients’ interest and our interest,” he said. “Somebody’s gotten hurt, and we’re all changed by it.”
In the case of unexpected outcomes, everyone is struggling to piece together what happened, Boothman said. But the practice of deny and defend “has denied that education to people.” The goal of open communication is to help providers get over the intense fear of being sued while ensuring patient needs continue to be met and their questions are answered.
Since implementing a disclosure policy, the health system has seen a decrease in malpractice lawsuits from 260 in 2001 to 100 by 2007, and legal costs have decreased on average 50% per case. Boothman said it is overreaching to directly link the policy to the fewer lawsuits, but having implemented disclosure practices has allowed the health system to look at malpractice lawsuits differently.
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.