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THIS WEEK'S EDITION:
- Question & Answer
- Sorry Works! is keynote address for Tennessee Risk Managers/On the Road Again
- Focus on Dr. Aaron Lazare
- Updates in Nevada and Arkansas on apology immunity bills SB 174/ HB 2387
- Northwestern Center for Patient Safety Kick-Off Conference - disclosure on the program!
- Reminder on Joint Commission Resources Conference on disclosure in June
QUESTION & ANSWER
QUESTION: "I'm a doctor and I want my hospital to do disclosure, but how do I convince my fellow physicians as well as the risk managers, attorneys, and administrators who seem so dead set against disclosure? They are good people but they are just so scared of lawsuits and trial lawyers. How do I break through this fear?"
Dr. Geri Amori: First I want to applaud you for recognizing the value and importance of disclosure. We live in a fear-based society - constantly bombarded by everything that can go wrong - so much so that sometimes we can become paralyzed by fear. The truth is, we might be "bitten" when we do the right thing. There is no guarantee that our right action will be rewarded. That being said, you are in the perfect position to be a role model and to educate those around you. My guess is that because you believe in open communication already, you probably have a good relationship with your patients. I would suggest that you start there.
Approach your Risk Management Team. Have a heart to heart with them about their beliefs about patient reactions to truth. Share some of your personal stories. Bring some of the articles you have read. Find out their specific fear related to your local situation. Let them know that you are available to be a champion to support making disclosure a part of the communication process.
Start talking with your colleagues and administration about the reality of lawsuits. Yes, they are costly and time consuming. What would happen if your organization took an approach like the University of Michigan and actively sought to resolve those situations where there was a known error and actively fought those situations where there was no error if a suit were filed?
Find out about your state statutes and how those might be affecting local reactions to disclosure. Be prepared to acknowledge those in your discussions with your risk managers, administration and colleagues. If you are so inclined, be willing to talk with people in your medical society and legislature about the need to remove some of the state barriers to open communication.
The most difficult thing you will need to remember is that you will not be successful overnight. Our system has been broken a very long time. Fears have amassed over years of punitive interactions in response to anger elicited by situations that were not handled well humanly or medically.
Disclosure alone will not "fix" the medical error problem. It must be accompanied by an organizational willingness to learn from errors and to improve systems. So long as we focus on whether or not to disclose, we are missing the greater point. We need to fix our systems. If we are unwilling to look honestly at our systems, we will remain hesitant to be honest with patients.
I encourage you to be patient. See yourself as a teacher and role model. Please feel free to contact us for supporting information, to come speak with your organization, or to counsel you as you plan meetings to discuss these issues in your organization.
Doug Wojcieszak: Education is the key! There has been so much bad information about liability floating around medicine and insurance circles for decades, that we must literally re- educate people. It can start with you.
There are countless articles and studies on the benefits of disclosure, and many of them can be found on the Sorry Works! website, www.sorryworks.net. Visit the website, download some articles, and distribute to your colleagues. Also, get your colleagues to sign up for this e-newsletter...there are some hospitals in the United States where over a dozen staff members have signed up for this newsletter. It's easy and free to sign up.
Next, work to bring in a Sorry Works! speaker (or speakers) to your hospital. A good presentation can help kick-off an institutional effort to implement a disclosure & apology program. A good speaker can get people talking and thinking about disclosure in a serious way.
With interest peaking, then work to form a committee of your colleagues to study developing a disclosure program. The team can work together to identify and overcome barriers and training tools for disclosure. There are lots of tools and support available for institutions seeking to implement disclosure programs.
Like all cultural changes and movements, there needs to be a champion or two who will advance the cause. Be a champion for disclosure in your institution. Change won't occur overnight, but if you are persistent change will happen.
Lastly - and most importantly - Sorry Works! is here for you to provide support, information, speakers, disclosure training, and other help. Call 618-559-8168 or e-mail doug@sorryworks.net anytime.
SORRY WORKS! IS KEYNOTE SPEECH AT TENNESSEE RISK MANAGERS/ON THE ROAD AGAIN
This Friday Sorry Works! spokesperson Doug Wojcieszak will be the keynote speaker at the Tennessee Society for Healthcare Risk Management in Nashville , TN. This is the third trip to the state for Sorry Works! From Nashville, Wojcieszak will head to Charleston, SC to speak to the major med-mal carrier in the state on Saturday. This is the fourth trip to the Palmetto State for Sorry Works! Then, next week Wojcieszak heads to Chicago to speak at three Adventist hospitals: LaGrange Memorial, GlenOaks Hospital, and Hinsdale Hospital.
If you are interested in a Sorry Works! presentation for your institution or organization, please contact doug@sorryworks.net or call 618-559-8168. Presentations can be tailored to fit your needs and generally last 30 minutes to 1.5 hours. Call or e-mail today!
FOCUS ON DR. AARON LAZARE
On May 9th, Dr. Aaron Lazare will be one of the featured speakers on the next Sorry Works! audio conference. Dr. Lazare is considered to be an international expert on apology, is often quoted by the media on stories regarding apology, and the author of the book "On Apology" published Oxford University Press. Last year, Sorry Works! published an interview with Dr. Lazare that we are going to republish in this newsletter today. If you wish to hear Dr. Lazare live, please register for the audio conference by calling Melanie Gober of RM&PSI at 517-886-8226 or copying and pasting this link into your browser for more information: http://www.sorryworks.net/conference1.phtml.
Dr. Aaron Lazare Interview:
The Sorry Works! Coalition is pleased to provide our readers with an un-edited interview with Dr. Aaron Lazare, M.D, Chancellor and Dean of the Massachusetts Medical School, and author of the book, "On Apology." Dr. Lazare's book is available at all major book stores and on-line. Also, contact information for his publisher is available under the Favorite Books section of this website. We hope you find this interview informative and enjoyable.
SW! Tell us in your own words why "On Apology" is an important book.
Dr. Lazare: An apology is one of the most important interchanges between individuals, groups, and nations. It is a communication that many of us long to receive from others and yet struggle to offer.
This book is important for several reasons. (1) It is one of just a few books on the subject of apology. (2) More than a "how to" book, On Apology attempts to understand the psychology of apology. (3) The book is organized into chapters that have relevance to every reader: why apologies are growing in importance, why apologies heal, the structure of successful apologies, the timing of apologies, why apologies are often delayed, motives to apologize, why people avoid apologizing, and why many apologies can be understood as negotiations between two parties. This organization and analysis clarifies why apologies succeed or fail. (4) The meaning and analysis of apologies are illustrated by numerous apologies from current affairs (e.g. recent presidents), history (e.g. Lincoln's Second Inaugural Address), literature (e.g. Homer's Iliad), and personal stories of the author, his friends and acquaintances. (5) The book explains why forgiveness is sometimes offered only in response to an apology. (6) The book’s personal and intimate style, enhanced by numerous stories, helps to engage the reader.
SW! You are the Chancellor and Dean of the University of Massachusetts Medical School. How has this book been received by your school?
Dr. Lazare: The book has been well received by students (medical students, graduate nursing students, biologic science PhD students), their faculty, and the parents of students. Its relevance goes beyond patient care and extends to relationships between peers, friends and family. Having
the chancellor/dean as the author of the book is a statement that civility is an important value of the institution. Other related values that the book advocates in stressing the importance of apologies are honesty, generosity, commitment and courage.
Most people advocate such values but are silent about them. Having the leadership of an institution reinforce them through a concrete piece of work (a book) facilitates their adoption.
The parents of medical students, with whom I become acquainted, commonly become advocates of the book to family, friends and their communities.
It is gratifying that two prestigious universities in Boston (a nearby metropolis) and two equally prestigious educational institutions in Dallas have organized major speaking engagements whose main focus is On Apology.
SW! What important lessons can doctors and health care providers learn from your book?
Dr. Lazare: The most profound lesson that doctors and health care providers can learn from On Apology is that apologizing to patients and their families for medical errors is both an ethical and a psychological remedy for damage to the professional/patient relationship. The apology is an ethical statement because is right to admit to a mistake and express regret and remorse in a relationship in which the patient puts his/her life in the caregiver's hands. The apology further heals the care giver/ patient relationship by the very nature of the acknowledgement, explanation, expression of remorse and offer of reparation. As a result of the apology, the relationship is usually preserved and often enhanced. This outcome is a result of the restoration of the dignity of the patient, the offering of power to the previously powerless patient, the validation to the patient that something went wrong, and restoration of or compensation for some or all of the damage for the harm that was done.
Doctors and health care providers can also learn how apologies resolve some of the offenses that naturally occur between health care professionals at work as well as within families.
SW! Your book has been well received in many different circles (legal, religious, business, etc.) Why are so many different groups of people hungry to learn about apology and forgiveness?
Dr. Lazare: The hunger for apologies applies to most individuals and groups who want to survive and thrive in the global village in which we all live. Certain groups, nevertheless, have a special interest in the apology process.
Religious groups are interested in apologies because of its similarities to repentance. Business groups are interested as they advocate teamwork in the company and customer satisfaction. Law schools are interested in apology as an important part of alternative dispute resolution. Hospice care organizations are interested since clients who are near death often want to apologize before they die. Health care providers are interested in apology in the context of medical mistakes. Conflict resolution groups both in business as well as in international peace seeking use apology as one of their tools. Finally, high schools and colleges use apology to teach civility and conflict resolution as character building. Many of the above groups are beginning to recognize the importance of apology and its application to their work. Equally important, they learn that the skill of apologizing can be taught and learned.
We hope you join us for the audio conference on May 9th - Dr. Aaron is a thoughtful and engaging speaker who will bring his unique insights to our audience. Call Melanie at 517-886-8226 to register today. Thank you!
UPDATES IN NEVADA AND ARKANSAS ON APOLOGY IMMUNITY BILLS (SB 174/HB 2387)
Several states are considering apology immunity laws this spring. Twenty-nine (29) have already passed such laws which provide immunity to medical providers who have apologized, offered expressions of grief, and, in some states, admitted fault. This week we provide you an update on Nevada and Arkansas and offer a little commentary for you, our readers.
Nevada Senate Bill 174 passed out of Senate Judiciary 4-3 last week, with all Democrats voting "no." While in committee, the SB 174 had the word "fault" removed from the bill, so the bill basically covers expressions of sorrow, grief, etc, which is how the language in most states reads. The bill's sponsor, Dr. Joe Heck, is uncertain about the bill's future in the Nevada Assembly, which is influenced heavily by the trial bar. It's a shame the fault provision was removed, and it will be a further shame if the bill dies in the Nevada Assembly. Trial lawyers and Democrats need to wake up and realize these apology immunity bills - with or withour fault provisions - are public relations pieces to encourage docs to do the right thing, but have little legal value. In fact, if a defense lawyer follows the letter of the apology immunity law and encourages a doc to cover- up and deny after apologizing and disclosing, bully for the trial lawyer! Apology and doing the right thing actually make for a great defense in a lawsuit. Let SB 174 pass and let's roll begin to roll back the years of bad advice given to physicians about apology and disclosure.
In Arkansas, an apology immunity bill - HB 2387 - which was introduced after prodding by numerous physicians, was defeated recently. We applaud Arkansas docs for their involvement and persistence; however, we have a message for them: Though apology immunity laws can make docs feel more comfortable about apologizing, you don't need these laws to implement disclosure and apology programs in your hospitals and insurance companies. Take your energy and drive and start implementing disclosure in Arkansas hospitals and insurers - now! As written above about Nevada, the bills are legal nothings anyway. They strictly have PR value. Look at the University of Michigan Health System, which has the largest, most successful, and well-publicized disclosure program in the United States. There is no apology immunity law on the Michigan books, yet their program is thriving. Yes, it will take work to make physicians comfortable, but the data is there as are the resources and support to start disclosure and apology programs.
NORTHWESTERN CENTER FOR PATIENT SAFETY KICK-OFF CONFERENCE - DISCLOSURE IS ON THE AGENDA
The kick-off conference for Northwestern University's Center for Patient Safety is scheduled for May 11th, and is free and open to all interested people. The conference's keynote speaker is Sorry Works! board member Dr. Albert Wu, and he will be providing two presentations at the conference, the second on disclosure of adverse events.
To learn more about the conference, paste the following link into your browser: http://www.medschool.northwestern.edu/bin/o/a/SaveTheDate.pdf.
REMINDER ON JOINT COMMISSION RESOURCES CONFERENCE ON DISCLOSURE IN JUNE
Joint Commission Resources is holding a two-day conference on disclosure with many of the nation's leaders on the topic, including several Sorry Works! board members. This will be a fantastic meeting. Dr. Michael Woods, Dr. Albert Wu, Dr. Steve Kraman, Dr. Lucian Leape, Rick Boothman (from Univ. of Michigan), Linda Kenney, Marty Hatlie, Dr. Rich Quinn of COPIC, Doug Wojcieszak, and many others will be there.
For more information, please paste this link into your browser: http://www.jcrinc.com/23681/
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