Steve Kraman
Richard Boothman
Below is an un-edited column submitted by Dr. Steve Kraman, former chief of staff at the Lexington VA, and Rick Boothman, chief risk officer at the University of Michigan. Kraman and Boothman designed and implemented the two best publicized and successful disclosure programs in American hospitals. What they have to say in this column is very important. Chiefly, they are concerned that all the hoopla surrounding Sorry Works! and the apology movement has glossed over the process that must be developed for successful disclosure programs. Kraman and Boothman want healthcare, insurance, and legal professionals to understand there is much more to successful disclosure programs than just saying, “I’m sorry.” We appreciate and applaud this contributions made by Kraman and Boothman. What they write in this column is exactly in-line with everything Sorry Works! preaches. However, it is also in line with our frustrations too….healthcare providers think they can just apologize and everything will be OK. Sorry Works! is much more than apologies, as explained by Kraman and Boothman.
Kraman/Boothman Column
The legislative proposal known as Sorry Works continues to generate interest and slowly spreads with proposed legislation in several states for pilot projects and a number of hospitals and healthcare systems supporting the practice. Outside the United States, Australia adopted a nationwide full-disclosure scheme (but one that is voluntary and lacks compensation rules or guidelines) and a bill, the NHS Redress Bill, is progressing along the legislative route in the English Parliament; it includes limited compensation for those injured by medical mistakes. Still, with evidence growing that Sorry Works-type
practices actually work to diminish malpractice claims and expense, and with the total absence of evidence supporting traditional deny and defend practices, we must ask why the movement seems so gradual.
The answer, we believe, may have something to do with the manner in which Sorry Works is portrayed. Sorry Works is often presented in a touchy-feely and self
righteous manner. The combination of the name “Sorry Works” and statements
that it is “the right thing to do” appeals to the public and even healthcare workers. However, risk management professionals, defense attorneys and insurers are flinty, hard-edged types who see the world as a dangerous place and equate soft-hearted with soft-headed. We suspect that many people in the business of risk management have not looked much beyond the apology part of Sorry Works. We can’t blame them as there is far too much attention being paid to the apology and even to disclosures. These aspects are only small parts of the whole.
The real key component in any successful claims management program, from ours at the Lexington VA, to the successful program at the University of Michigan, to that described by Sorry Works is competent case assessment and principled management with a backbone. Medicine is inherently dangerous. Even the most seemingly benign actions by the most careful of health care professionals, like prescribing an antibiotic for an ear infection, is fraught with potentially devastating consequences. Knowing the difference between reasonable and unreasonable care is key and resolving to act accordingly is the answer.
At the University of Michigan and the VA hospital at Lexington (the only two
hospitals to publicly air their financial outcomes), risk management is a
hard-nosed system based first, on working hard to know the difference between reasonable and unreasonable care and next, resolving to take advantage of no one and allowing no one to take advantage of you. Hospital managers who donąt have these capabilities or processes in place to know the difference are naturally loath to admit any error because they don’t know how many others are lurking, or because it is easier for them to let the litigation system ultimately ferret out the distinction however expensive that method may be. The fear is in the unknown. A constant litany of “doing the right thing” wonąt persuade the doubters. They have to understand this as the management issue that it is. Apart from the nuances of “Sorry Works” and other such approaches, to gain real ground we need to frame the problem and the solution in real and realistic terms.
Perhaps the two of us have been as guilty as any in not representing this the
correct way. Unfortunately, the “Sorry Works” brand seems to focus on the apology component. The name has stuck, but the full breadth of the concept needs further explanation and realization. Those of us who have practiced “Sorry Works”-type programs need to emphasize the whole concept rather than just the “soft” parts. Ultimately, it IS about “doing the right thing” but doing the right thing for everyone concerned, health care professionals and institutions, as well as our patients, and it starts by knowing the difference and having the backbone to act accordingly.
Steve Kraman, M.D
Professor, University of Kentucky
College of Medicine, Former Chief of Staff
Lexington, VA Medical Center
email: sskram01@uky.edu
Richard Boothman, J.D.
Chief Risk Officer, University of Michigan
Health System
email: boothman@med.umich.edu
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