 | “Open communication, thorough investigation, and meaningful resolution with a patient after an unanticipated medical outcome can enhance patient safety, help the patient understand what happened, preserve the patient-clinician relationship, and reduce the need for legal action.” |
From the Collaborative for Accountability after Medical Injury, summing up the critical elements of successful Communication and Resolution Programs – and I couldn’t agree more!
Collaborative members and researchers Michelle Mello and Tom Gallagher, and Patient Liaison Leilani Schweitzer were panelists on a recent webinar hosted by The Risk Authority/Stanford University that I watched with great eagerness. They were discussing the results of several AHRQ Demonstration Projects published last year that revealed increasing success with Communication and Resolution Programs at several academic medical centers (50% reduction in claims in the early settlement programs at the Universities of Michigan, Illinois and Stanford) as well as with the limited reimbursement programs offered by three very progressive insurers (COPIC, Coverys, WVMIC).
What were the important takeaways from the webinar? Let me start with Leilani Schweitzer, who lost her son as a result of an adverse outcome at Stanford Hospital some years ago. Leilani felt that there is value in being transparent with patients and families when an adverse event occurs, that it tells patients that their experiences matter, and that shared organizational learnings about what happened helps patients find meaning in their suffering. She emphasized the importance of timely conversations to rebuild trust (in what are very intimate events for patients) as well as having a dedicated and skilled resource to turn to during a very difficult time. And she said what we know to be universally true, that patients and families want 3 things:
1. An apology for what has happened, including responsibility for what occurred
2. The dignity of an explanation
3. And improvements to patient safety
Patients can feel like strangers lost in a strange land, Leilani said, and doing nothing does a lot – and speaks volumes. Critically, she also said that sometimes just having answers is having a resolution – because it’s not solely about compensation – there is value in knowing what happened and why.
Michelle Mello, a PhD/JD Professor of Law at Stanford Law School and Professor of Health Research and Policy at Stanford School of Medicine said that 2/3s of the opportunities for excellent communication following adverse events at the subject hospitals did not involve a breach of the standard of care – highlighting an important point. Many med/mal lawsuits are brought with tenuous liability connections (which is why the success rate of these types of suits is lower than in other civil actions) principally because no one at the healthcare provider explained what happened, although something did. By proactively reaching out to patients and families following an adverse event, the organization helps to rebuild the trust that is often damaged when one’s hopes and expectations about a successful outcome are not met.
Tom Gallagher, MD, who has been involved in the disclosure and transparency movement for over a decade, reported on the key lessons learnt from their review of the early resolution programs:
1. It’s a sprint followed by an ultra marathon – you need to devote adequate resources to ensure success
2. Most resistance will be passive, and will occur on the brink of implementation – best to be prepared for it
3. Physician engagement is the key to success – since the physicians are the individuals that the patients and families really want to hear from when something goes wrong
4. Can’t just dip your toe in the water – you also have to be vigilant about adverse event reporting, too (and Michelle Mello put it succinctly – “you have to go hard or go home” – running it in just one department won’t give you the numbers you need to show results)
5. More resources are becoming available to assist healthcare organizations set up Communication and Resolution Programs – things like the upcoming AHRQ CandOR (communication and optimal resolution) Tool Kit, the fabulous MACRMI website, the Collaborative and of course, chiResolutions – your best partner to help your organization design and implement a successful Communication and Resolution Program that fits your organizational culture.
Collaborative members and researchers Michelle Mello and Tom Gallagher, and Patient Liaison Leilani Schweitzer were panelists on a recent webinar hosted by The Risk Authority/Stanford University that I watched with great eagerness. They were discussing the results of several AHRQ Demonstration Projects published last year that revealed increasing success with Communication and Resolution Programs at several academic medical centers (50% reduction in claims in the early settlement programs at the Universities of Michigan, Illinois and Stanford) as well as with the limited reimbursement programs offered by three very progressive insurers (COPIC, Coverys, WVMIC).
What were the important takeaways from the webinar? Let me start with Leilani Schweitzer, who lost her son as a result of an adverse outcome at Stanford Hospital some years ago. Leilani felt that there is value in being transparent with patients and families when an adverse event occurs, that it tells patients that their experiences matter, and that shared organizational learnings about what happened helps patients find meaning in their suffering. She emphasized the importance of timely conversations to rebuild trust (in what are very intimate events for patients) as well as having a dedicated and skilled resource to turn to during a very difficult time. And she said what we know to be universally true, that patients and families want 3 things:
1. An apology for what has happened, including responsibility for what occurred
2. The dignity of an explanation
3. And improvements to patient safety
Patients can feel like strangers lost in a strange land, Leilani said, and doing nothing does a lot – and speaks volumes. Critically, she also said that sometimes just having answers is having a resolution – because it’s not solely about compensation – there is value in knowing what happened and why.
Michelle Mello, a PhD/JD Professor of Law at Stanford Law School and Professor of Health Research and Policy at Stanford School of Medicine said that 2/3s of the opportunities for excellent communication following adverse events at the subject hospitals did not involve a breach of the standard of care – highlighting an important point. Many med/mal lawsuits are brought with tenuous liability connections (which is why the success rate of these types of suits is lower than in other civil actions) principally because no one at the healthcare provider explained what happened, although something did. By proactively reaching out to patients and families following an adverse event, the organization helps to rebuild the trust that is often damaged when one’s hopes and expectations about a successful outcome are not met.
Tom Gallagher, MD, who has been involved in the disclosure and transparency movement for over a decade, reported on the key lessons learnt from their review of the early resolution programs:
1. It’s a sprint followed by an ultra marathon – you need to devote adequate resources to ensure success
2. Most resistance will be passive, and will occur on the brink of implementation – best to be prepared for it
3. Physician engagement is the key to success – since the physicians are the individuals that the patients and families really want to hear from when something goes wrong
4. Can’t just dip your toe in the water – you also have to be vigilant about adverse event reporting, too (and Michelle Mello put it succinctly – “you have to go hard or go home” – running it in just one department won’t give you the numbers you need to show results)
5. More resources are becoming available to assist healthcare organizations set up Communication and Resolution Programs – things like the upcoming AHRQ CandOR (communication and optimal resolution) Tool Kit, the fabulous MACRMI website, the Collaborative and of course, chiResolutions – your best partner to help your organization design and implement a successful Communication and Resolution Program that fits your organizational culture.
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