Is it really better to say you're sorry? From the institutional perspective of a hospital, the answer is typically a resounding no.
Apologizing for medical errors invokes fears that the gesture will be construed as an admission of guilt that leads to a massive payout. But a small cohort of providers is pushing back against that idea. Backed by the Agency for Healthcare Research and Quality, they have been using a process called Candor, short for communication and optimal resolution.
They say it improves patient safety and quality of care, and they also hope it can save hospitals money.
“If we can't be open and honest about these events, we're never going to learn from them and be able to fix our processes and systems,” said Dr. David Mayer, vice president for quality and safety at MedStar Health, eight of whose 10 hospitals, located in the Baltimore-Washington area, participated in a pilot program for the Candor toolkit.
In the past four years, MedStar has lowered serious safety events by almost 60%, Mayer said. He said he could not attribute that reduction entirely to Candor, however, as the hospital had simultaneously been carrying out other techniques to reduce risk and preventable medical harm.
The Candor toolkit contains videos, PowerPoint presentations and other documents explaining a variety of activities, including how to hold conversations with patients and families and how to implement disclosure programs across an institution.
The priority with disclosure programs was to improve patient safety and reduce errors, Mayer said, although saving money is also a motive. “Our claims have been reduced because we come to this solution early,” he said. “As long as the lawyer on the other side is truly willing to work with us and come up with a fair and equitable remedy, we settle those cases quickly.”
MedStar defines medical error broadly, as whenever “care goes in the direction that we hadn't anticipated,” Mayer said, and its goal is to tell a patient or family within 15 minutes of a medical error occurring.
Patients in hospitals experience harm from errors including foreign objects left inside during surgery, procedures performed on the wrong part of the body, and incorrect medications or doses.
“Many times, that first conversation is, 'We don't know what happened, but we promise we will figure out what happened, and as we figure out what happened we will share it with you, and if appropriate, we will apologize,'” Mayer said.