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Doug Wojcieszak, Founder & Spokesperson
Contact phone/e-mail address: 618-559-8168; doug@sorryworks.net
SPECIAL NOTE: Instead of the usual newsletter format, for this edition we will be focusing on one topic: A report on the new disclosure program at the University of Illinois Medical Center in Chicago . We hope you find this newsletter informative.
NEW DISCLOSURE PROGRAM AT UNIVERSITY OF ILLINOIS MEDICAL CENTER IN CHICAGO
Back in March (2007), the University of Illinois Medical Center's Assistant Chief Medical Officer made a presentation on their new disclosure program at the Chicago Patient Safety Forum's Annual Meeting. Sorry Works! recently received a copy of the tape and we were very impressed with the presentation.
First, before we provide a summary of the presentation, a big tip of the hat is in order to the Chicago Patient Safety Forum (CPSF). Lenny Lamkin, Steve Maxwell, and the entire CPSF team have done outstanding work promoting and supporting disclosure and apology. The disclosure movement owes them a debt of gratitude. Here's why we are in their debt: Two years ago disclosure was not the hot topic it is today - it was controversial, at best - and The Sorry Works! Coalition was a brand new organization with more detractors than supporters, especially in our home state of Illinois . Nevertheless, CPSF Director Lenny Lamkin took a chance on Sorry Works! and disclosure by hosting a panel discussion on the issue. He took some static from folks around the state, but Lenny persisted in inviting Rick Boothman from the University of Michigan, Dr. Steve Kraman, retired Lexington VA Chief of Staff, and Doug Wojcieszak, Sorry Works! founder and spokesperson to provide a panel discussion for the CPSF 2005 Annual Conference. The room was packed with staff from Chicago-area hospitals. One of those people in attendance was Dr. Tim McDonald of the University of Illinois Medical Center in Chicago . The presentations excited Dr. McDonald, especially Boothman's talk. Dr. McDonald and his team soon visited the University of Michigan Hospital System - the most successful and best publicized disclosure program in the United States - and learned about their program. In his March 2007 talk, Dr. McDonald shared experiences from the first year of the UI program. It's a fantastic story, as you will read below.
We are proud to report that many other Chicago-area hospitals present at the 2005 CPSF disclosure panel are also developing disclosure programs, and we hope to share their success stories soon. So, a big tip of the hat to the Chicago Patient Safety Forum (www.chicagopatientsafety.org). By taking a chance, the CPSF folks greatly advanced the cause of disclosure and apology and we owe them many, many thanks. Furthermore, we hope other organizations follow the example set forth by the Chicago Patient Safety Forum.
Now, on to the report. As discussed earlier, Sorry Works! has reviewed a taped copy of Dr. McDonald's presentation. Fantastic presentation and Dr. McDonald shares a lot of the same passion and enthusiasm for the topic exhibited by other leaders in the field.
What follows are several observations about the UI program, some of which are new and different for disclosure programs:
- The University of Illinois Medical Center went from a hospital that practiced "deny and defend" to today where their goal is to investigate, apologize, settle or mediate, and learn from mistakes in 60 days or less. Speed is one of the hallmarks of this program. Dr. McDonald emphasized that they try to complete most investigations in 72 hours or less. They have a real system in place to move fast when adverse events happen so they quickly collect the information, figure out what happened, and work with the patient/family.
- In one year of conducting the program, UI has had 40 disclosures but only one claim! Remember, this is Cook County , Illinois , which the American Tort Reform Association considers to be the 2nd worst judicial hellhole in the United States . Conventional wisdom would counsel "shut up and don't say a thing," but they have done the exact opposite at the UI over the last year and the results have been very impressive.
- In establishing their program, UI program leaders got buy-in from all sectors of their system, including high-risk specialities, administration, guest services, PR folks, the Board of Trustees, and the University President, Joe White. President White was actually a pretty easy sell because he was at the University of Michigan when they implemented their disclosure program.
- The biggest barriers UI faced was outside defense counsel. Dr. McDonald shared a story that when they were starting their disclosure program the medical center was also interviewing for new outside counsel. During interviews, a question was posed to the prospective attorneys how they would handle a surgery where the wrong leg was removed. Twelve of the 16 firms counseled deny and defend, and one even advocated altering the medical record to imply that the "wrong leg" needed to be removed anyway! Amazing. Dr. McDonald said you have to find defense counsel who will accept litigating cases before the courts only on damages.
- Dr. McDonald said insurers can be an issue too; however, with UI they are self-insured for the first $15 million. Insurers are indeed an issue, but we hope - for example - that ISMIE Insurance (the dominant doctor mutual in Illinois ) pays close attention to the UI experience. If UI can make it work in Cook County , it can work anywhere...it's just a matter of making it happen, and doctors and hospitals are anxious to try it. UI has shown that disclosure can work in Cook County (and elsewhere), so it's just a matter of ISMIE working with their insureds and local hospitals to develop a program, which is very doable. Doctors and hospitals want to do disclosure. UI has figured out that anger - not greed - drives most med-mal lawsuits, and if you have good customer service with excellent communication and problem solving techniques after adverse events, litigation will be reduced. Hopefully ISMIE and other insurers will figure it out too.
- Again, one claim in 40 disclosures. Tremendous savings on individual cases by investigating, apologizing, and fixing problems in a swift, fair fashion. "Fixes" involve waiving bills, child care expenses, lost wages, and, yes, even writing checks.
- Dr. McDonald shared several moving stories, including an event where a patient was given a massive overdose of cancer-fighting drugs. The patient was in excruiating pain and bleeding everywhere. The providers sat on the incident for a few days and felt horrible. Some providers became physicially ill, while others couldn't sleep. However, McDonald's team learned about the event, investigated quickly, and organized a disclosure meeting. The patient couldn't believe the honesty and candor. She was so glad to hear that she wouldn't be sick anymore, and that the problem was not with her. Furthermore, she was pleased the mistake was identified and corrected so it wouldn't happen to someone else. Finally, her bills were waived, which pleased her too. As for the providers, they got a huge load of their chest and felt so much better afterwards. It's all about healing!
- UI has a rapid investigation team as well as a error disclosure team trained in communicating with patients and families after adverse events.
- Billing is part of the process - with one key stroke all billing is stopped to a patient/family after an adverse event. This is an important point because often a bill or collection notice sent to a patient or family can literally blow the lid off a situation.
- UI also have a patient liason to work with the patient/family constantly and make sure they never feel abandoned after the adverse event.
- Support services have been implemented for providers as well to help them after disclosure. Remember, medical errors produce two (2) victims, both of which need to be treated. UI is doing it.
- They have an anonmyous hotline to report adverse events to the risk team. This is especially helpful for lower level people to report.
- They have developed a robust review system that is non-punitive to discuss and learn from mistakes. Processes are improved and medicine is made better, which benefits everyone and further reduces risk!
Those are the highlights from the Univ. of Illinois presentation at the CPSF meeting. Quite a story and look forward to hearing more about UI's successes. We also hope this will spur other hospitals and insurers to action.
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