Service Recovery: 'HOW TO' GUIDE FOR DISCLOSURE AND APOLOGY

[NRSKarenRN, BSN, RN]

found @ physician's news digest

october 2008

'how to' guide for disclosure and apology

by james w. saxton, esq. & maggie m. finkelstein, esq.

disclosure and apology are hot topics in the health care industry, and there is no sign of the heat waning. in fact, with patient-focused health care initiatives and patient safety initiatives, the authors anticipate that disclosure and apology post-adverse event will only get hotter.

transparency, benchmarking, hospital and doctor ratings, and pay-for-performance initiatives only make disclosure and apology more significant in the health care industry. certainly, disclosure and apology are a part of patient satisfaction. by disclosure and apology, we are really talking about communication post-adverse event. did you talk to the patient and/or family after the unexpected outcome occurred? did you empathize with them? did you explain to them, clinically, what occurred and why? when these conversations do not take place after an adverse event, patients and their families may misconstrue the silence as concern or guilt on your part. they also will often seek out a lawyer to fill in the gaps and answer their unanswered questions. it is why disclosure and apology post-adverse event are key risk reduction strategies for physicians.

we are often asked, "how this can be so - isn't discussing with a patient what happened and saying i'm sorry going to lead to a lawsuit - it's just like admitting that i committed malpractice. in the past, my attorney has always told me to keep quiet after an unexpected outcome occurs." the truth is that when done in the right way, communication post-adverse event can actually prevent or help in the defense of a lawsuit. the key is in doing it right. in this article, we will provide you with the tools to get past many of the barriers to disclosure and apology as well as provide you with an introductory "how to" - when it actually happens

[Neveranurseagain, RN]

I am an RN and and my husband died of a "medical incident" at age 47. Hospitals/MD need to change the "system" on how families are handled after an event. A simple, "I'm sorry..." goes along way. After the incident happened, no one would talk to me, except a few brave healthcare professionals, and I had to make all the decisions myself, including taking him off life support after 5 days. No one approached me on D/C life support and I had to bring it up to them after his pupils blew. They never discussed if it should be done or not.

After a possible medical event, I feel a team needs to be assigned to the family/pt. to help them through what happened and answer questions. This would relieve the RN assigned to the pt. who can focus on pt care, not be afraid of what the family is going to say/do. Any questions or concerns would be addressed to the team, with a contact person available 24 hrs a day.

Read some of my early posts in reference to medical malpractice. Some of them are real eye openers...

My being able to work as an RN since this episode is over. But I enjoy reading/learning about new trends in nursing as being a nurse will always be in my blood and I appreciate allnurse.com. And thanks to the settlement, I can stay at home with the kids.

[Straydandelion]

after a possible medical event, i feel a team needs to be assigned to the family/pt. to help them through what happened and answer questions

i agree fully with this. the hospital i worked in once had a team similar but concentrated on "difficult" patients/family. the team consisted of someone on the ethics committee (non-medical), social service, nursing, doctor. chaplain and others deemed adviseable according to the situation. this resolved unresolveable issues quite a few times, but would have been even better if more readily accessable for other areas of the hospital.

the truth is that when done in the right way, communication post-adverse event can actually prevent or help in the defense of a lawsuit.

i have seen more then one adverse event avoid lawsuit totally by the honest/caring discussion between medical professionals and patients/families. medicine is not an exact science, there will be events though we would all like as few as possible.