Research shows an upfront explanation of what happened along with an apology helps to deter expensive litigation and improve patient safety.
Deny and defend is out. Saying “I’m sorry” is in. Research has shown in cases involving patient injuries or adverse effects, an apology and explanation does not lead to an increase in lawsuits. It’s a new way of thinking for many physician leaders.
“Historically, the response was deny and defend. This was a response where people said as little as possible to the patient. That deny-and-defend model has been discredited,” says Thomas Gallagher, MD, professor and associate chair of the Department of Medicine at the University of Washington and executive director for the Collaborative for Accountability and Improvement. “Not only is it the right thing to do, but it also leads to fewer lawsuits and an increase in patient safety.”
According to a study of two Massachusetts hospital systems, published in October 2017 in Health Affairs, a straightforward explanation of what happened along with an apology helps to prevent litigation and improve patient safety.
This new approach comes in the form of communication-and-resolution programs, or CRPs, which focus on informing patients and families as soon as possible after an error and learning from the mistake to prevent it from reoccurring.
“It is a total shift,” Gallagher says.
If appropriate, proactive financial compensation is also part of the program. In deny and defend, a patient had to file a lawsuit to get honest information about what happened and compensation. Using the communication-and-resolution model, hospitals and other medical entities are more forthcoming.
Gallagher says most medical errors are not a result of incompetence, but rather system failures or honest mistakes.
“It really shakes clinicians to their core and leads to a lot of self-doubt,” he says, making it more likely for them to make mistakes with other patients.
Also, the additional pressure on providers that comes from a need for secrecy and perfection often leads to clinician burnout.
“When something goes wrong, rather than hiding it, it needs to be reported to the health care organization right away,” Gallagher says.
That’s the first step with the CRP approach. What follows is open communication with patients and families about what happened, followed by analysis of the event. During this stage, it’s important to get to the bottom of what went wrong to prevent reoccurrences.
“It’s a model that aligns with most physicians’ ethos,” Gallagher says.
Keeping things inside and not being able to talk about events can lead to stress for the clinician. Care and support for the clinician and proactive offers of appropriate compensation from the organization are the final parts of the process.
It’s about meeting patients’ needs without requiring them to sue. “Being more open actually decreases the number of malpractice cases,” Gallagher says.
Data backs that claim. In the Massachusetts study, two large hospital systems showed positive results in liability costs and patient safety improvements. Researchers looked at 989 adverse events from 2013 to 2015, and only 5 percent led to malpractice claims or lawsuits. If there was compensation, the median payment was $75,000 compared with the nationwide median payment after a malpractice lawsuit of $225,000.
The shift began over the past decade and is gaining momentum, with about 200 health care organizations implementing CRPs this year, Gallagher says.
“Organizations are seeing their competitors adopt a communication-and-resolution program and don’t want to be left behind. We’ve reached a tipping point,” he says. “It’s really approaching the standard of care, and that’s exciting.”
Gallagher says he is not aware of an organization that went back to deny-and-defend after changing.
Many liability insurers and risk managers are getting onboard also, and that system-wide buy-in is important, Gallagher says.
“This is not the type of initiative one leader can push on their own,” he says. “There are a variety of groups that need to come together and understand.”
Some liability insurers are even offering incentives for organizations that adopt the CRP model.
Going all in is essential.
“To do this requires a culture change, and to do that culture change requires systematic implementation,” Gallagher says, adding that organizations can’t use it in some situations and not others.
“It takes a little getting used to. You use the whole model every time there is an adverse event. What these programs are about is changing the culture of health care.”
Tiffani Sherman is a freelance reporter based in Florida.