Relationship-Centered Communication: The Foundation for Effective Disclosure of Adverse Medical Events

Relationship-Centered Communication: The Foundation for Effective Disclosure of Adverse Medical Events

By William Maples, MD, Executive Director for The Institute for Healthcare Excellence

Dr-Maples

Every day more than one million adverse events occur throughout the American health system, however it is estimated that less than 1% of these events are disclosed to patients and families.  Why is this?  On review of the literature, a summary of what we understand about disclosure of adverse events is as follows:

  • Patients’ dissatisfaction with a nonclinical component of their care, such as breakdown in communication or loss of trust, has been found to prompt claims.
  • If harmed, patients overwhelmingly prefer to be told so by their physicians.
  • Successful disclosure of medical errors to patients requires careful planning, preparation, and coordination by providers and hospital administration.
  • Patients who felt their doctor were “somewhat likely” to disclose errors were significantly less likely to sue than patients who felt their doctor was “not at all likely” to disclose.   There has been no evidence that there is an increase in tendency to file a lawsuit.
  • Patients who indicated their physicians would be very likely to disclose a medical error would recommend the hospital more than twice as often as patients with no confidence in the likelihood to disclose.
  • Lawsuits are often associated with the injured patient’s perceived lack of open and honest communication on the part of the physician.
  • Providers are concerned about voluntary disclosure due to threat of triggering additional medical malpractice law suits, thus raising the overall cost of delivering care
  • Providers are concerned about voluntary disclosure due to threat of triggering the defection of current patients and alienating prospective patients, thus reducing revenue.

A recent article in the Wall Street Journal from May 11, 2015, “The ‘Michigan Model’ for Malpractice reform highlighted the benefits of a communication and resolution program called 3Rs Program (Recognize, Respond, and Resolve) which was implemented in 2002.  Open claims halved between 2001 and 2004 (Boothman 2004).  Attorney fees decreased from $3 million to $1 million per year (Berg 2004), new claims decreased from 7.03 to 4.52 per 100 thousand patient encounters, lawsuits decreased from 2.13 to 0.75 per 100 thousand patient encounters, the time from claim report to resolution decreased from 1.36 to 0.95 years.  In addition cost rates fell for total liability, patient compensation, and non-compensation-related legal costs.  (Kachalia, et. al. Ann Int Med. 2010. and Localio editorial same issue).

Prior to the Michigan program, the VA Medical Center in Lexington, KY adopted a full disclosure policy in the late 1980’s.  Results of this program demonstrated increased settlements with reduction in the mean malpractice settlement payout.

At the core of an effective disclosure program is the ability to recognize and respond appropriately, i.e. effectively communicating with the patient and family.  Developing and nurturing skills that enable patient and family-centered communication is essential to achieve the gains of a transparent disclosure program.  Once these foundational skills are developed, a decision making process can be implemented to encompass the complexities of each individual medical situation that is underlying the adverse event.

The Institute for Healthcare Excellence (IHE), recognizing the foundational role that effective patient-centered and compassionate communication has in creating a culture of safety, enhancing outcomes, creating an excellent patient and family experience, and achieving efficiency, has developed a skills based curriculum that has resulted in significant measurable improvement in compassionate communication, teamwork, mutual respect, and safety/outcomes metrics.

Once these core communication skills are in place,  a framework and program for disclosure of adverse events can be implemented with a true partnership between patients/families, physicians/providers, allied health staff, and administration.  The goals for implementing the communication and disclosure program include preserving the physician-patient relationship, providing a timely/sensible response to assist the patient’s journey to physical, emotional, and financial wellness, and provide a supportive and caring environment for the healthcare team.  In addition, the financial/legal gains outlined above have been demonstrated in multiple institutions.

Please contact William J. Maples, M.D.  (wmaples@healthcareexcellence.org), Executive Director, to explore how the IHE programs may be incorporated into your institution’s journey.

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