In spite of these successes, the changes put in place at UMHS and UIC can seem far from feasible at many hospitals.
HHS' Agency for Healthcare Research and Quality recognized those difficulties, as well as the link between patient safety and medical liability programs, and in June 2010, the agency allocated roughly $23 million to fund seven demonstration projects and 13 planning grants to develop and test new patient-safety and medical liability reform models.
UIC's McDonald is heading up one such grant. He was awarded nearly $3 million to roll out the “seven pillars” in nine Chicago-area hospitals. None of those hospitals are self-insured, says Dr. David Mayer, associate professor of anesthesiology and associate dean for curriculum at UIC. That's important, says Mayer, who is also working on the grant, because the changes will be translatable in other non-academic hospitals.
Dr. Kenneth Sands, senior vice president and chairman of the department for healthcare quality at Beth Israel Deaconess Medical Center, Boston, and Dr. Alan Woodward, president of the Massachusetts Medical Society, were awarded one of AHRQ's planning grants for about $274,000.
With help from the University of Michigan's Boothman, they used the funds to conduct in-depth interviews with 27 key stakeholders, identify a list of barriers to implementation and draft a road map to implement a disclose-and-offer policy in Massachusetts hospitals. They unveiled the road map at a conference on March 17.
“Our goal was to gather information and see if this works so well in one setting like Michigan, what are the barriers for uptake in other settings,” Sands says. “We wanted to see why this wasn't catching on like wildfire.”
The interviews uncovered a number of issues, such as lack of understanding about how a disclose-and-offer system works, physician discomfort and state liability laws. Also, the state of Michigan has what is referred to as a six-month “cooling off” period that requires a waiting period before filing a lawsuit. That gives institutions a chance to work toward a resolution, and Massachusetts doesn't have that, Sands says.
There are legislative efforts under way in Massachusetts to facilitate the process, but there is plenty that can be done in the meantime to cultivate an environment that encourages adoption, Woodward says. The next step is to build a coalition with other interested parties that want to move in this direction, and there are many, he says.
“The point is, if you take the fear out of the system, people are much more prone to have open and honest communication,” Woodward explains.
The University of Michigan Health System, meanwhile, has plateaued at roughly 83 to 93 open claims at any given time, Boothman says. The system reached that mark in 2007 and hasn't been able to make any further progress since then, he adds. The next step toward lowering that number will be to focus on improving shared decisionmaking and making sure patients are informed and have realistic expectations.
Boothman is hopeful that by taking those steps, UMHS can halve its number of open claims within the next four years.
He also says more hospitals and insurers are coming around to the idea of full disclosure of errors. In addition to providing guidance for the Massachusetts grant, he is also working with groups in New York and Washington state.
“I think it is finally sinking in that we can debate other options, but all of them are counter to patient safety except this one,” Boothman says. “This starts with acknowledging the problem, and that is essential to improvement. You can't tell the world, ‘I didn't do it,' and then turn around and try to fix what went wrong. If we are going to get better, we have to quit the baloney.”