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IN THIS EDITION:
- New Facts and Figures on UM Health System - pay attention insurance companies!!
- Q&A Section Receives Upgrade: Dr. Geri Amori
- CME/CEU credits for Sorry Works! Audio Conference
- On the road again....
- Healthcare Executive Article on Disclosure
New Facts and Figures on UM Health System - pay attention insurance companies!!
Earlier this week Rick Boothman of the University of Michigan Health System gave a fantastic presentation on the successes of their disclosure program to the New Jersey Council of Teaching Hospitals (more info below). Boothman and UM Hospital System have been publicized a lot over the past couple of years, but it seems like every time they give a talk or provide an interview they have something new and exciting to share. Consider the following from Wednesday's talk - and please make sure you pass this on to your friends in the insurance industry....they really need to be reading this stuff:
Point #1: Since the disclosure program started in 2001, UM Health System has reduced their reserves from $72 million to approximately $20 million. This is money that has been pumped back into the hospital system for patient safety improvements and other worthwhile efforts. Obviously, UM’s actuaries – the folks who really know the numbers - are getting very, very comfortable with the program. What does this tell you, insurance people??
Point #2: In 2001, UM Health System had 262 claims and suits, now they have fewer than 100 claims/suits.
Point #3: Transaction expenses have dropped from $48,000 in 1997 to $21,000 in 2003.
Point #4: Opening to closing times for cases have fallen from an average of 20.7 months to 9.5 months.
How has the UM medical staff viewed the program? In a recent survey, 98 percent of UM Medical staff said they support the program, and 55 percent said the disclosure program was a "significant factor" in their decision to stay at UM Hospital System. How that's for the folks who are concerned about keeping doctors in their hospital system or particular community?? Who ever thought disclosure could help with physician retention??
How has the Michigan trial bar viewed the program? In a recent survey, 100 percent of trial lawyers said they view UM as "the best" and "among the best" health systems for transparency. Eighty-one percent of trial lawyers surveyed said they had changed their approach because of Michigan's disclosure program. Eighty-six percent of trial lawyers said transparency allowed them to make better decisions about claims to pursue, and 57 percent said they turned down cases they otherwise would have pursued. Finally, seventy-one percent said they had settled cases for less than had they litigated.
This is amazing.....UM has been able to change the behavior of the trial bar in ways that 40 years of tort reform hasn't. What's that old saying...."you catch more flies with honey than vinegar? Or, you might say if you treat trial lawyers like the human beings they are.....if you treat their clients (i.e, patients and families) like the human beings they are.....then good things can and will happen. It's really common sense, folks. Just good customer service.
UM's successful approach is based on three simple principles - here they are:
Principle #1: UM will compensate quickly and fairly when inappropriate medical care causes injury.
Principle #2: UM will defend medically appropriate care vigorously.
Principle #3: UM will reduce patient injuries (and therefore claims) by learning from mistakes.
That's it....that's the philosophy and approach in a nutshell. Kinda simple, isn't it? Boothman says he can't find anyone who honestly degrees with these three guiding principles. Easy to understand why – they make sense!
Q&A Section Receives Upgrade: Dr. Geri Amori
Over the last three weeks we have successfully launched the new Question and Answer section. We have received a lot of positive feedback. Well, this week we are upgrading the Q&A section with the addition of Dr. Geri Amori.
Geri is a Senior Director at the Risk Management & Patient Safety Institute, a former president of ASHRM and a nationally renowned speaker and teacher on disclosure. We are happy to have Geri sharing her insight and experience through the Q&A section which will now be named, "Ask Geri & Doug."
To ask Geri and Doug a question send an e-mail to doug@sorryworks.net and/or gamori@rmpsi.com. Your identity will remain confidential.
This week's question is from a surgeon.
QUESTION: I really like Sorry Works - this is great stuff. I am part of a wonderful group of surgeons who do great work, but even in our group mistakes will happen. How do we compensate these patients and families? Do we establish our own self-insurance pool or fund, or should we be working with our insurance carrier? Where does the money come from for the early offer component of Sorry Works? Thanks.
ANSWER:
Doug: This is an important question. The ideal situation is to communicate and work with your insurance carrier to get them to adopt the Sorry Works! approach. Money from early offer settlements should be paid by your insurance policy/insurance carrier. Before you say, "That will never happen!" we encourage you to let your insurance carrier know that you - their customer - want to do Sorry Works. You might be surprised at the reaction, because many insurance carriers are already studying and evaluating Sorry Works! and disclosure programs. The insurance industry really likes what they are hearing about the reduction of litigation and associated litigation and settlement expenses with the Sorry Works! approach. However, one of their stumbling blocks is that they, the insurers, think that you, the physicians, will never accept Sorry Works. So often we hear from insurers, "Well, Sorry Works! is great, but our docs will never go for it. They'll never apologize and admit mistakes." So, it is vitally important for you, the physicians and healthcare professionals to let your med-mal insurers know you want to do Sorry Works! The same thinking and approach also holds for hospitals and healthcare organizations that are not self-insured: Your leadership (hospital administrators, medical leadership) also needs to let your insurer (s) know that your hospital and medical staff want to do Sorry Works! Make the call today. If you run into doubters or brick walls at your insurance company, don't give up. Be persistent. Send them the link to the Sorry Works! website. Forward the Sorry Works! newsletter to them. You are the insurance customer and you need to let the insurers know Sorry Works! is what you want.
Geri: Doug has said something important. It is up to us to teach our insurers the new culture of Sorry Works! Many physicians and healthcare organizations have begun to realize that early resolution works, whereas many of our insurers, attorneys, and state professional boards haven't moved as fast as we have to embrace this approach.
It is essential that you work with your insurer or your self-insured entity when it comes to compensation!
As a risk manager, I suggest you not jump the gun and rush to compensate patients and families until you know the cause of the adverse event and that you work with your risk manager and/or your insurer to plan how to approach the issue of compensation. Disclosure is not a single event. The initial discussion is most frequently one that reveals the unanticipated outcome and the medical/physical results. Most often the causes are not known until after some analysis of the event. During that time you, with the help of your risk manager and insurer, determine that apology and compensation are appropriate. The Sorry Works! philosophy is that of a supported team. Errors occur because we are humans and work in flawed systems. Apology and compensation are appropriate when our errors or systems failings have injured a patient. Risk management and our insurers are there to support us and compensate patients and families for system and human errors. Together it is our job to do the right thing for patients, to support providers, and to strive to learn from error to improve healthcare safety.
Final point: We are here to help insurance companies and medical organizations that are trying to figure out how to actually implement successful disclosure and early-offer programs. We have several teaching products that can help. If you need help, give us a call at 618-559-8168 or e-mail doug@sorryworks.net.
Send your questions to gamori@rmpsi.com and/or doug@sorryworks.net.
CME/CEU credits for Sorry Works! Audio Conference
The Sorry Works! Audio Confernce on November 14th will provide education credits for healthcare professionals. Here are the details.
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of The Risk Management and Patient Safety Institute (RM&PSI) and The Sorry Works! Coalition. RM&PSI is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. RM&PSI designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)TM.
Application for 1.8 contact hours has been submitted to the Michigan Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
For more information on the audioconference including a downloadable registration form, visit this link.
To register, contact Melanie Gober at 517-886- 8226 (phone), (517) 327-4604 (fax), or e-mail: mgober@rmpsi.com.
On the road again...
This coming week on October 13th, Doug Wojcieszak of Sorry Works! will be the keynote speaker at a joint meeting of the Arizona and Western States Orthopaedic Surgeons in Santa Fe, New Mexico. For registration information, contact Patrice Hand, Arizona Orthopaedic Society, 602 246-8901; PatriceH@azmedassn.org.
We owe a big thank you to the Utah Orthopaedic Surgeons, New Jersey Council of Teaching Hospitals, and the Wisconsin Society for Healthcare Risk Management for hosting Sorry Works! over the last week – it’s been a whirl wind week.
In New Jersey: Dale Micalizzi (of the Sorry Works! board), Dr. Lucian Leape of the Harvard School of Public Health, and Rick Boothman of the University of Michigan Health System were awesome. Dale gave a moving example of why disclosure is so important to patients and families; Dr. Leape really delivered a wonderful speech to his colleagues (doctor to doctor/healthcare professional) on why the time for disclosure is now; and Rick Boothman drove it home with the successes they have experienced at the UM Health System with disclosure.
Dr. Leape's closing remarks and advice should be taken to heart: doctors and healthcare professionals need to tell insurance companies that disclosure and honesty is the best way to treat patients and families. Dr. Leape said doctors need to demand disclosure programs from their insurance companies. Bravo!
Yesterday in Wisconsin a wonderful group of speakers including Dorie Rosauer of Medical Protective, Dr. Cynthiane Morenweck of the Medical College of Wisconsin, and James Roberts, General Counsel for University of Wisconsin Hospitals & Clinics gave great presentations.
We learned yesterday that University of Michigan is not the only school in the Big Ten doing disclosure - Wisconsin has a good program too and we applaud their efforts with patients and families.
Dr. Morgenweck gave a great speech - she's really good. As a retired anesthesiologist and current bioethics professor, she brings a lot of great ideas and issues to the table in a very credible manner. For instance, one line from her speech was very striking: "There's less to remember with the truth." How true. When you tell the truth, you never have to get your "story" straight with all the other folks in the hospital. This one line alone from Dr. Morgenweck is why disclosure makes all the sense in the world, and deny and defend doesn't. Think about it.
One of the great problems with covering up medical errors is that the people on the cover-up end (the docs, nurses, risk managers, adminstrators, etc) are all very smart people who are in the caring business....kinda hard to get all those people to shut up and toe the line. The truth is gonna leak out somewhere. Patients and families will find out someway, somehow from some medical professional with a conscience leveling with them....or by a trial lawyer banging away in depositions. Far better to tell the truth upfront then be exposed as a fraud who tried to cover-up. Indeed, telling the truth is easier. Bravo, Dr. Morgenweck!
Healthcare Executive Article on Disclosure
Below is a great article by Dr. Paul Hoffman that our friends at Healthcare Executive allowed us to republish.
Responding to Clinical Mistakes
Management’s role requires thinking first of the patient and family.
Paul B. Hofmann, DrPH, FACHE
Q: Despite everyone's best efforts to prevent medical errors, some mistakes will still occur. Considerable attention has been devoted to the role of physicians in dealing with this issue, but what is management's role?
A: The public is increasingly aware of the potential problems patients may encounter during hospitalization and outpatient treatment. Based on the findings of the Press Ganey 2005 National Healthcare Satisfaction Report, the greatest concern of patients is not privacy, tests, treatments or staff but the hospital's response to their concerns and complaints.
To maintain the public's trust in our healthcare institutions, the organization has an irrefutable obligation to promote patient safety by taking every practical step to prevent mistakes. But this is not enough. Management has an additional responsibility to establish a comprehensive policy that is consistently applied when errors happen.
Pivotal Questions for Setting Policy and Procedures
Prior to developing policy and procedures regarding clinical mistakes, a number of critical questions should be considered. These include:
• How should the organization’s vision, mission and core values influence the disclosure of errors and the actions taken?
• How will the policy ensure that a patient-centered approach is promoted in dealing with errors?
• What constitutes a clinical error that should be disclosed?
• Are errors that have no measurable impact on patients addressed differently from those that do?
• What will be the roles of the nursing staff, risk management office, compliance office, human resources department, legal counsel, administration and public affairs office?
• What should be communicated to patients and families when an error occurs, and who should be speaking with them?
• Under what circumstances does the organization communicate with other staff members, the governing body, outside regulators and the media?
• What information will be released, to whom and when? How are such communications handled?
• How will the organization deal with the individual(s) involved in the error in a blame-free and just culture?
• How will the organization address the system deficiencies that account for most mistakes?
• Is it necessary to provide a safe and anonymous means for staff members to report errors that have not been reported previously? And regardless of such steps, what is required to ensure retaliation will not be permitted or tolerated?
• What mechanisms have been developed to support proper involvement of patients and family, timely root cause analyses and other steps to reduce clinical mistakes?
A policy on disclosing clinical mistakes should begin with a preface that describes not only its purpose but also why the institution’s core values mandate compliance with the policy. The preface should note the importance of (a) recognizing that errors will happen, (b) acknowledging them and apologizing when they do, (c) performing thorough investigations, and (d) taking steps to minimize future mistakes. The balance of the policy and the accompanying procedures should address the questions raised above.
Think First of the Patient and Family
One simple litmus test should be used in evaluating the policy's adequacy and relevancy: If you were the patient who had been hurt by a clinical error or were a member of that patient's family, what would be your expectations?
First, you would want acknowledgement that a mistake was made. Moreover, this disclosure should be prompt, accurate and in terms you can understand. Specifically, you deserve to know what happened, how it happened, what are the consequences for you, whether those consequences are temporary or permanent, and who will be responsible for the incremental costs associated with any necessary treatment.
As important, you would not want the disclosure to be delayed until every single detail of the error is known. This is a predictable tendency of healthcare organizations but not one that meets your need for timely disclosure and a promise of more information when it is available.
Second, you would expect an apology. And of course, it should be genuine and candid, not scripted and impersonal. Because you did not anticipate being harmed during your hospitalization or outpatient visit, you will be upset. If someone says they are sorry and expresses sincere regret, patients and families will still be angry, but their anger may be partially dissipated by an admission of remorse. People understand mistakes can happen; they do not and should not need to understand why no one has accepted responsibility, admitted there was a problem and apologized for it.
Third, you would expect to be informed about steps underway to investigate why the error occurred and what measures will be taken to prevent similar errors from recurring. It may be small solace to know others will be at less risk in the future, but patients and their families can be somewhat comforted by this knowledge.
Fourth, you would expect a preliminary indication that some form of compensation will be forthcoming. Although still subject to debate, risk managers and healthcare attorneys are aware of growing evidence that both the likelihood of a lawsuit and the size of settlements often are diminished when a timely and appropriate offer is made to compensate for the pain and suffering associated with the mistake.
Final Thoughts Healthcare institutions are belatedly encouraging and promoting the concepts of transparency and disclosure. Working diligently to acquire and retain the public's trust, hospitals and other providers should remember that patients and families realize staff members are fallible and some mistakes inevitably will occur. However, these same patients and families also share the view of Sir Liam Donaldson, chief medical officer of the United Kingdom Department of Health: "To err is human; to cover up is unforgivable; and to fail to learn is inexcusable."
Paul B. Hofmann, DrPH, FACHE, is president of the Hofmann Healthcare Group and co-editor of Management Mistakes in Healthcare: Identification, Correction and Prevention, published in 2005. Dr. Hofmann coordinates the ACHE annual ethics seminar; programs also can be arranged on-site. For more information, please contact ACHE's Division of Education at (312) 424-9300 or visit ache.org.
Hofmann Healthcare Group
1042 Country Club Dr., Ste. 2D
Moraga, CA 94556
(925) 247-9700
hofmann@hofmannhealth.com
This article was printed in the September/October 2006 issue of Healthcare Executive and is reprinted with permission. For copies of this article, please contact ACHE at he-editor@ache.org.
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