|
|
|
In January 2007, several Harvard University researchers published a paper on disclosure. This paper can be found at this link. Below is our response to the paper, and also at this link is the response from Dr. Steve Kraman and several Australian physicians.
SORRY WORKS! RESPONSE TO HARVARD DISCLOSURE STUDY
The journal Health Affairs recently published a study on disclosure and its potential cost impacts by five Harvard researchers (Studdert et. al; January/February edition). We applaud attempts to better understand and research disclosure. The authors take many novel approaches to attempt to quantify the total systematic cost of claims if all healthcare institutions conducted disclosure. They surveyed numerous experts (attorneys, physicians, risk mangers, insurance professionals, etc) on the potential value of claims and then fed these results into a computer model. Surprisingly, the model said overall claims would cost more with disclosure, not less. Why the difference between the model and the numerous institutions and organizations reporting reduced litigation and cost savings with disclosure? The answer can be found in the methodology used by the Harvard researchers.
The real experts are not medical, insurance, and legal professionals in a simulated study but the patients and families who have actually experienced adverse medical events. Unfortunately, not even the most gifted researcher can replicate the positive emotional impact of disclosure on patients and families and how those feelings influence financial decisions and litigation. If this sounds "touchy feely" it is, because in the words of Sorry Works! board member Dr. John Banja disclosure "is all about the feelings." By constructively addressing feelings after adverse events, disclosure mitigates anger among patients and families and the urge to financially punish doctors, hospitals and insurers. This "touchy feely stuff" is the reason that disclosure reduces lawsuits and settlement costs.
Yes, claims (not lawsuits) may increase with disclosure, as the Harvard researchers suggested in their study. However, it appears that the Harvard researchers operate in the typical mind frame that medical malpractice is "all about the money." When institutions conduct disclosure, money becomes a secondary or tertiary issue, as it should be. Disclosure acknowledges the humanity of patients and families, which mitigates anger, and when anger is off the table people can become very reasonable and creative about what constitutes fair compensation. Yes, sometimes checks - even big checks - will have to be written to pay for the damage caused by medical errors, but they're not "jackpots" because patients and families are not trying to punish the institution. Furthermore, there are plenty of stories coming from disclosure institutions where patients and families have had - for example - patient safety lectures or wings of hospitals named after loved ones. There are also plenty of incidents where compensation was rejected completely by patients and families simply because the "sorry" was good enough.
Simply assuming that every disclosure event will result in a claim where significant sums of cash are paid - as the Harvard researchers did - is a bad assumption and shows a total lack of understanding of what truly motivates patients and families after adverse medical events.
Furthermore, the Harvard researchers did not quantify the reduction in litigation expenses for meritorious claims as well as the decrease in non-meritorious litigation with disclosure. Across the med-mal industry, seventy to eighty percent of claims are closed with no compensation being paid. These are major costs factors that are a real drag on the med-mal industry with traditional deny-and- defend risk management strategies - and disclosure's ability to rein in these costs is one of the big selling points for institutions considering Sorry Works!
Given all reasons above, the only feasible way to measure the financial impact of disclosure is to directly study institutions conducting disclosure. However, this was the most surprising facet of the study: The authors did not study real-world institutions conducting disclosure! There are many institutions that are reporting positive experiences for their bottom line with formal and informal disclosure programs (most notably the University of Michigan), but the authors simply did not contact or study these organizations. Surprising and disappointing.
Future studies should more closely study the phenomenon of disclosure and apology in medical and insurance organizations that are actually operating disclosure programs. However, please understand: Institutions that embrace disclosure and apology undergo massive culture changes with numerous tangible and intangible financial benefits. It will be difficult if not impossible to measure the financial and other benefits of disclosure in a computer model. Instead, researchers interested in future studies on disclosure will need to engage in the painstaking efforts of observing and understanding organizations conducting disclosure. We look forward to such efforts.
|
|
|
|
