July 1, 2009
Doug Wojcieszak, Founder & Spokesperson
Contact phone/e-mail address: 618-559-8168;
doug@sorryworks.net
President Obama's recent healthcare reform speech to the American Medical Association re-sparked the decades-old debate about medical malpractice reform. The President hinted at a willingness to support some reforms, but not the caps on non-economic damages coveted by doctors. Some of the doctors booed, while trial lawyers surely smiled. And the doctor-lawyer fight over malpractice reform rolls on.
Perhaps it's time we changed the focus of this debate? We need to shift the discussion from a political and legal fight to a focus on customer service and how to help the doctor-patient relationship transcend a medical error, and in so doing avoid costly litigation in most instances while improving quality and safety - and saving a whole lot of money in the process!
A growing body of evidence in the peer-reviewed medical literature shows that patients and families primarily file lawsuits against doctors because of anger, not greed. Patients and families become angry with their doctors (and nurses, hospitals, insurance companies, etc) when communication, honesty, accountability and - literally - good customer service are lacking after a perceived error. In other words, patients and families are suing not so much because of errors, but because of the bad behavior surrounding errors. The doctor abandoning the family. The nurses turning cold. The hospital administration promising investigations and meetings, and never following through. These cover ups anger patients and families, and attract the attention of trial lawyers - even when there is no true medical error!
In response to this data, several hospitals and insurance companies across the United States (and around the world) have begun adopting disclosure and apology programs – what is often called Sorry Works! The most celebrated example is the University of Michigan Health System, which has cut lawsuits by half, reduced litigation expenses by two-thirds, and reduced their reserves from $72 million to less than $20 million in eight years. Other university hospitals such as the University of Illinois, Stanford, and Harvard have followed suit.
Community hospitals such as Valley Hospital and Liberty Health System in New Jersey, Geisinger Health System in Pennsylvania, Catholic Healthcare West, and Brigham and Women's in Boston are reporting similar successes with disclosure. Insurers such as the Central Pennsylvania Physician Risk Retention Group and PLICO, the physician-owned mutual insurer of Oklahoma, have adopted disclosure programs.
These hospitals and insurers are teaching their providers that patients and families can actually live with errors, but not cover ups. They are training their doctors how to be pro-active in the face of tragedy and work with patients and families to meet their emotional and financial needs.
At the heart of Sorry Works!, is a disclosure program. In the program, doctors and nurses are taught how to be empathetic, caring, and stay connected with patients and families when something goes wrong. Providers are taught how to say "sorry" in context without prematurely admitting fault ("I'm sorry this happened...we feel bad for you") while promising the patient or family an investigation. The doctors and nurses then contact the hospital and/or insurance leadership to initiate a quick and credible investigation.
The investigation will determine if a mistake happened, or not. If a mistake occurred that led to an injury or death, the providers working with their insurer and defense counsel will meet with the patient/family to apologize, admit fault, explain what happened, and negotiate fair, upfront compensation with a signed waiver. If, however, the investigation determines that no mistake occurred, the providers still meet with the patient/family to explain the results of the investigation, answer questions, and continue providing empathy and support - but no settlement is tendered (and all lawsuits will be contested).
This honest and candid approach dramatically reduces anger experienced by patients and families and, in most instances, removes the urge to pursue litigation. Not only do patients/families receive answers and support, they also learn how the particular mistake will be prevented in the future, thus improving quality & safety - a key component of all major healthcare reform proposals! Nothing improves quality and safety like doctors and nurses owning mistakes! Nothing.
The early offer component of Sorry Works! is truly no different than the fast-tracking of claims in most major insurance companies, with one major exception: speed. Sorry Works! is pro-active and customer service orientated...doctors and hospitals don't wait for the plaintiff's attorney to request records before springing into action. Instead, they work hard to maintain the patient-provider relationship from the moment something goes wrong. Doctors remain engaged instead of hiding and running away.
To be fair, doctors, nurses and hospital and insurance executives are fearful. For decades, they have been instructed by defense attorneys and risk managers that their words will be used against them in court. Better to simply clam up. Thirty-five states have passed apology immunity laws where "sorry" can not introduced into evidence. Furthermore, then-Senators Obama and Clinton introduced legislation in 2005 to encourage the development of disclosure and apology programs, and perhaps this legislative language will be revived in the President's healthcare reform package. Passage of such laws can make doctors feel more comfortable about saying "sorry," but they are truly not necessary. The evidence created in the disclosure process actually creates a strong defense for those cases that do move forward to litigation. The defense lawyer can tell the judge and jury how the doctor was compassionate, caring, and tried to do the right thing. Case in Point: The State of Michigan has no apology immunity laws on the books, but the University of Michigan Health System is the most successful and well-publicized disclosure program in the country.
By not needing legislation, Sorry Works! helps doctors break the malpractice reform gridlock. Instead of depending on politicians and judges to do the job for them, doctors can do the job themselves by providing outstanding customer service to their patients and families after an adverse event. Sorry does work!
Doug Wojcieszak is the founder of The Sorry Works! Coalition (www.sorryworks.net), based in Glen Carbon, IL. Phone: 618-559- 8168 (direct dial); e-mail: doug@sorryworks.net.
Again, please forward this special column to friends, colleagues, as well as elected officials and members of the media. Thanks!
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