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THIS WEEK'S EDITION:
- JCAHO Disclosure & Apology Conference a Great Success
- New speaking opportunity: Delaware Association for Healthcare Quality
- Sorry Works! webinars
- Question and Answer
- Nebraska becomes 30th state to add apology law
JCAHO DISCLOSURE & APOLOGY CONFERENCE A GREAT SUCCESS
The JCAHO Disclosure & Apology Conference in Chicago , IL was indeed a great success last week. Over 120 people attended the event, and it was a nice mix of medical, hospital, insurance, and legal professionals from around the United States and Canada . We are hoping JCAHO will host another event like it next summer or fall (2008). Some of the highlights from the event included:
- Dr. Michael Woods, Author of Healing Words, made a great point that the majority of med-mal claims are caused by poor communication AND the majority of medical errors are also caused by poor communication. So, improving physician and nurse communication will effectively kill two birds with one stone!
- Dr. Lucian Leape set the tone by exclaming that physicians and medical professionals have received "lousy advice" from insurance companies when it comes to adverse events. Leape said for far too long doctors have been told to clam up and not speak to patients and families. Leape issued a call for physicians to retake medicine by demanding that their insurance companies institute disclosure and apology programs.
- Dr. Steve Kraman spoke about disclosure and apology pilot programs taking place in Australia with the results to be released later this Fall. Kraman also mentioned that there are many hospitals, insurers, and risk management groups in the United States that are trying disclosure and apology quietly. He encouraged more organizations to come forward with their success stories and share them. The more success stories that are shared, the sooner disclosure and apology will be mainstream.
- Rick Boothman spoke about what it takes to start a disclosure program. Specifically, Boothman recommended starting small, publicizing your success stories with your staff, insurer, and other important parties, and continually reinforcing the culture and growing your program.
- Both Kraman and Boothman did a very fine job reviewing and discussing disclosure case studies during a break-out session. Hopefully, if JCR does this meeting again more time will be committed to case study discussions. This was a very useful and practical part of the program that risk managers, claims managers, physician leaders, and administrators will benefit from greatly.
- COPIC Insurance said 2,990 physicians - almost half their insureds - are participating in their successful yet voluntary 3Rs disclosure program. COPIC shared some other interesting numbers too: The average cost for their claims/suits with no indemnity paid is $27,980; the average cost their claims/suits with indemnity paid is $258,799; while the average amount paid per 3R incident is $5,224. No wonder COPIC is expanding their 3R program to their Nebraska insureds (for more news on Nebraska read below).
- Doug Wojcieszak, Sorry Works! founder & spokesperson, concluded the conference by emphasizing customer service after adverse events and stressing the importance of disclosure and apology programs.
All and all, it was a great conference. Very useful teaching and learning experience for all participants. We sincerely hope JCAHO repeats this valuable conference next summer or fall and that even more participants register. Thank you!
NEW SPEAKING OPPORTUNITY: DELAWARE ASSOCIATION FOR HEALTHCARE QUALITY
This past week Sorry Works! secured another speaking engagement with the Delaware Association for Healthcare Quality. SW! spokesperson Doug Wojcieszak will be speaking at the group's statewide meeting next April.
To book a Sorry Works! speaker for your association, Grand Rounds, risk management conference, or other meetings contact doug@sorryworks.net or call 618-559-8168. Thank you!
SORRY WORKS! WEBINARS
The Sorry Works! webinars being conducted by SW! spokesperson Doug Wojcieszak have been very successful and well-received. So far, Wojcieszak has provided an overview of the apology and disclosure movement as well as a primer on how physicians should apologize to patients/families after adverse events. This week on Wednesday (1pm EST) Wojcieszak will be providing an overview of how to start a disclosure program, and next week (Wednesday, 1pm EST) he will be discussing the most common questions and rebuttals to Sorry Works!
For a complete listing of Sorry Works! webinar courses with times, dates, and registration information, please visit the following link.
QUESTION & ANSWER
Question for this week: Our hospital is implementing a disclosure and apology program. We have our own insurance and some of our docs are covered by our insurance, but we have several independent physicians covered by their own malpractice carrier. We have spoken with the independent's malpractice carrier about Sorry Works! but they are resistant to disclosure and apology. What do we do? What happens if we have a case where we are partially at fault and an independent physician is also partially at fault? How do we handle this case under a Sorry Works! protocol?
Doug: First, you continue to try convincing the malpractice carrier covering your independent physicians to participate in the program. Change will not happen with one or two conversations. Often, it takes lots of repetition to get through to people and alter their behavior. Second, you encourage the malpractice carrier to at least try disclosure and apology on one case...a test case, if you will. Perhaps a case smaller in value. If you get the carrier to go along, publicize your success with this case to your independent physicians. Third, if the malpractice carrier continues to be resistant to change, then you need to inform your independent physicians and encourage them to find another malpractice carrier; many malpractice carriers are considering Sorry Works! The malpractice carrier needs to know they might start losing insureds because of their resistance to Sorry Works! Fourth, if you have a case where both your hospital and the independent's malpractice carrier are on the hook, you need to be open and honest with all parties: the patient, family and their counsel, the hospital staff, and the independent physician(s) and their carrier. You need to let people know that you believe a mistake was made and you - the hospital - will be disclosing, apologizing, and compensating. In reality, this happens all the time in litigation with multiple defendants where one of the guilty parties decides to quit fighting and settle the case. However, with Sorry Works! you are being much more pro-active, short circuiting anger and litigation, and saving the hospital and your staff time, grief, and money. The independent physician and his/her carrier will be left to fight on their own, and hopefully learn the folly of their ways!
Geri: Doug is correct. You cannot let the insurance company of the independently covered physicians stop you from doing what you believe to be in the best interest of your patients and, ultimately, your organization and physicians. At the same time, I recommend you remain sensitive to the fear that creates the resistance. Change of a long-standing behavior that "worked" in the past will only occur when you are able to demonstrate the benefits of the new method. Furthermore, I invite you to consider re- defining "success" with both your insurer and the outside insurance company. In the old days, we focused on indemnity payout as the measure of success. When we paid no or a small amount of indemnity, we felt better. When we paid more to the patient we felt worse. Part of the "no-tell" philosophy was based upon "winning" and paying less indemnity. We knew we spent a tremendous amount of money paying legal fees with this approach, but were told "it was worth it." Furthermore, there was the uncalculated cost of lost time on the part of physicians and others, the cost of the discovery process, and finally the cost of reputation and emotional injury to both providers and patients. That was just considered "part of it." We are suggesting a different perspective. We do NOT advocate a no- fault system. We are NOT recommending an apology and payment when we did not cause the harm. However, by re-defining successful management of an error as a process resulting in : maintaining trust and respect, PLUS decreased time in adversarial negotiations, decreased total cost, and decreased psychological damage to all involved parties - THEN I think you can begin to demonstrate to both your insurance company and the company of the independent physicians how this new approach might, indeed, be more satisfactory.
Regarding your question about handling situations where both you and the independent physicians have responsibility: You can only do what is right for you. Of course, you should be involving your attorney. You don't want to assume more responsibility for the error than is appropriate. At the same time, independent counsel might learn from the experience of working through the process with you. It won't be easy for you. You may find yourself walking an ethical tightrope, or wanting to throw in the towel. However, I encourage you to stay the course. Often the greatest nay-sayers become the greatest supporters when they see close-up the benefits of doing what is ultimately right for their clients. Good luck!
NEBRASKA BECOME 30TH STATE TO ADD APOLOGY LAW
Nebraska became the 30th state in the Union to add an apology immunity law to the books when Governor Dave Heineman signed LB 373 into law on May 21, 2007. The law makes expressions of apology, sympathy, and remorse following an adverse medical event inadmissable in a civil action.
Of course, as we at Sorry Works! have said all along, if disclosure is done right in the auspices of a program these so-called apology immunity laws have little legal utility. If an error occured and a physician/hospital apologized, admitted fault, explained how the problem will be corrected, and offered compensation AND still was sued, then the apology and candid acts provide a great defense. A physician shouldn't want to pretend as though the apology didn't occur. The apology immunity laws can make docs feel more comfortable about apology and hasten reform efforts for disclosure advocates, but defense lawyers should have little interest in using them.
To see a complete list of states with apology laws, visit the following link.
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