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July 23rd, 2007 NEWSLETTER
Doug Wojcieszak, Founder & Spokesperson
Contact phone/e-mail address: 618-559-8168; doug@sorryworks.net
THIS WEEK'S EDITION:
- New Sorry Works! engagements...Is your organization interested in a presentation on disclosure?
- Docs need support after mistakes/Sorry Works! can help develop support programs
- Sorry Works! & Disclosure Movement Featured on Nurse.com
NEW SORRY WORKS! ENGAGEMENTS....IS YOUR ORGANIZATION INTERESTED IN A PRESENTATION ON DISCLOSURE?
Sorry Works! accepted two new speaking engagements this week: Illinois Risk Management Services 23rd Annual Meeting in September and the Kentucky Society for Healthcare Risk Managers in November. We are pleased and excited about these presentations, but we want more speaking engagments before medical, risk, and insurance organizations. Sorry Works! makes a great presentation for Grand Rounds and insurance seminars for physicians as well as state-wide (or regional) meetings for medical, risk, and insurance groups.
Is your organization interested in a presentation on disclosure? If yes, please call 618-559- 8168 or e-mail doug@sorryworks.net for more information. Thank you!
DOCS NEED SUPPORT AFTER MISTAKES/SORRY WORKS! CAN HELP DEVELOP SUPPORT PROGRAMS
Below is a story that ran last week on all the wire services concerning providers' need for help and counseling after errors. This is a serious issue. Patients and families are hurt by medical errors, but so are providers...yet there is very little attention paid to the pain and suffering experienced by providers. The situation is aggravated by deny and defend risk management practices that instructs providers to keep their mouths shut and bottle it up. Such "advice" places an enormous emotional toll on providers who clearly need to unburden themselves after an error and get healing. There is a reason many major religions advocate confession. It's good for the soul!
Sorry Works! can help. Part of developing a successful program involves providing support services for providers who have committed errors. Sorry Works! and their partner Stevens & Lee law firm and risk management consultants develop disclosure programs for medical and insurance interest which include support mechanisms for providers. To learn more, click on this link: http://www.sorryworks. net/training1.phtml.
In today's NPSF listserve discussion, Dr. Umesh Prabhu of the United Kingdom discussed how 8 to 12 UK physicians commit suicide annually after mistakes. Dr. Prabhu also partially blamed higher rates of alcoholism on providers not being able to effectively deal with errors. Making an error does not make a doctor or nurse a bad person. It simply means they are human, and as humans we all need help from time to time. As disclosure becomes more prevelant we will have a better opportunity to help providers, and Sorry Works! is here to assist.
Doctors suffer too after making medical errors
Most say they wanted counseling after errors, but little support available
July 19, 2007
CHICAGO - Patients are not the only ones harmed by medical errors, according to a survey that found many doctors who make mistakes and even those who come close - suffer stress, sleep problems and loss of confidence.
Job stress related to medical errors potentially could make some doctors prone to depression, quitting or even making additional mistakes, underscoring the need for helping them cope, said Washington University psychologist Amy Waterman, the lead author of the study which was released Wednesday.
Most doctors surveyed said they would have liked counseling or other help after making mistakes, but that hospitals and other health care organizations did not offer much assistance.
The survey involved 3,171 doctors in St. Louis, Seattle and Canada who answered mailed or e-mailed questionnaires. Most - 2,909 of them â said they had been involved with a near miss, minor medical error or serious error, which includes mistakes causing permanent or potentially life-threatening harm.
The results appear in the August edition of The Joint Commission Journal on Quality and Patient Safety, published by an affiliate of The Joint Commission, a hospital regulatory group involved in efforts to reduce medical errors in the U.S.
44,000 die annually of medical mistakes
Many of those efforts stem from an influential 1999 report that estimated that at least 44,000 Americans die each year from medical mistakes.
While the survey's scope was limited, the results echo smaller studies and likely apply to doctors elsewhere, the authors and experts not involved in the research said.
Dr. Donald Berwick, a Harvard professor who runs the Institute for Healthcare Improvement, said even more doctors might be adversely affected in regions where reforms aimed at reducing medical errors have not taken hold.
"Nobody thinks that this excuses or should minimize" the suffering of patients harmed by errors, but it is important to emphasize that doctors suffer, too, Berwick said.
Of surveyed doctors involved in errors, 61 percent said they felt increased anxiety about the potential for future mistakes, 44 percent said they became less confident in their job abilities, 42 percent experienced sleep problems and 42 percent had a loss in job satisfaction.
Only 10 percent said hospitals offered them adequate resources for dealing with mistake-related stress.
Doctors involved in serious errors were most likely to report increased job-related stress. Still, increased stress also was reported by one-third of those involved in near-misses.
Worrying about 'What if?'
Dr. David Jaimovich, chief medical officer for The Joint Commission affiliate in suburban Chicago, said he recalls feeling stressed after a colleague got a decimal point wrong and almost gave a young patient too much medicine. Jaimovich said he and a nurse noticed the error in time but that "the first thing you think of is, 'What if?'"
Another time, he had to treat a child who'd been sickened by an overdose resulting when a colleague calculated the dose based on kilograms rather than the child's weight in pounds.
The child recovered "but we still felt terrible," Jaimovich said. He was not involved in the survey.
Historically, physicians have been looked on as being almost "super human" and when they made mistakes, "they were supposed to bite their lip, suck it up and keep going," Jaimovich said.
That perception has eased, and hospitals are starting to offer services to help doctors cope, he said.
While hospitals are increasingly adopting a more open approach to acknowledging errors, many still fear lawsuits and won't let doctors even discuss their mistakes, let alone offer them help, Berwick said.
He said doctors need self-esteem and optimism to effectively treat patients, and that more openness and coping resources for doctors could lead to improvements that would reduce errors.
"Who wants a wounded healer?" Berwick said.
SORRY WORKS! & DISCLOSURE MOVEMENT FEATURED ON NURSE.COM
Sorry Works! and the disclosure movement were recently featured on Nurse.com. The story is below.
If you know reporters who cover medical, risk and insurance issues, please have them contact Sorry Works! spokesperson Doug Wojcieszak at 618-559-8168 or doug@sorryworks.net. Sorry Works! makes a great story. Thanks!
Sincere Apologies Are Priceless
Rita Marie Barsella, RN, BSN
Monday July 2, 2007
In health care, an apology can make a world of difference. When an unexpected outcome occurs or an error is made, Doug Wojcieszak, founder of The Sorry Works! Coalition, says an apology is essential to an organization's full disclosure program. Wojcieszak recently spoke at "Seeing Your Way Clear to Apology and Disclosure," a conference, hosted by The Joint Commission, that extolled the virtue of apology and full disclosure in health care's culture.
The Joint Commission requires that accredited hospitals have full disclosure policies. But policy and practice are two different things. The U.S. Department of Veterans Affairs (VA) has a system- wide practice of full disclosure. Their program was modeled after a program started by Steve Kraman, MD, at the VA hospital in Lexington, Ky. Several other hospitals, including the University of Michigan Health System, have developed similar disclosure practices. In 2005, based on the success of the VA's program, The Sorry Works! Coalition was formed.
Wojcieszak says programs that promote open communication and full disclosure are the answer to tort reform. He says lawsuits are generated by anger and the current medical malpractice crisis is actually a customer service crisis. Wojcieszak speaks from experience. He founded The Sorry Works! after the death of his brother.
Personal tragedy fuels the movement
Wojcieszak's brother was admitted to an Ohio hospital for pain. He died during his hospitalization. An autopsy revealed he had had at least two untreated myocardial infarctions as an inpatient. The family looked for answers and an explanation, but the hospital refused communication. They sued the hospital and won a sizable amount -- minus an apology.
"It made money the only thing worth fighting for," says Wojcieszak. He says to this day, his mother still grieves that they never received an apology.
According to Wojcieszak, an apology should be offered as soon as an adverse event occurs. He says the apology does not equal an admission of guilt, but it demonstrates an acknowledgment of the event and an assurance that an investigation into the root cause of the event will take place.
Wojcieszak does not advocate frivolous payouts. He says there are three core principles to successful disclosure programs such as the ones implemented at the VA and the University of Michigan:
1) Quick and fair compensation when inappropriate medical care causes injury
2) Vigorous defense of medically appropriate care (there should be no compensation if there is no fault)
3) Learning from mistakes and implementation of changes to prevent future errors
"Medicine is not perfect, and human beings are not perfect," says Wojcieszak. "We have adverse events, and we have adverse events with errors. Right now, unfortunately, the system is set up to take good people with good intentions and turn them into bitter, ugly enemies. It produces anger by the bucketful and litigation by the truckload."
Wojcieszak says the medical community needs to stop waiting for legislation to solve the malpractice debate. He says programs involving apology and full disclosure are not rooted in legislation but start with hospitals and practitioners making a commitment to their customers -- the patients and their families.
Let the healing begin
During the two-day Joint Commission conference, several speakers addressed the value of a sincere apology, while others reinforced the need for transparency and accountability with full disclosure. It was said that just, swift compensation, when appropriate, is an important component of full disclosure.
Several speakers cautioned that apology and disclosure are not blanket protection against litigation, nor should that be the motivation for implementing disclosure programs. Rather, they said, apology and full disclosure are part of the future of healthcare improvement.
Michael S. Woods, MD, author of Healing Words: the Power of Apology in Medicine, said there is a misconception that an apology is about guilt. He said an apology is about empathy rather than guilt.
"We suffer from the 'deny and defend' medical culture," said Woods. He labeled the perception that an apology leads to liability a "myth." Woods said an apology is the "natural progression of a respectful relationship."
When an unexpected outcome occurs, Woods suggested saying "I'm sorry. I know this is not what you expected. It's not what I expected either." To be sincere and believable, Woods said apologies cannot be relegated to severe, adverse outcomes; they should be inherent to the health practitioner's daily practice.
Woods said an apology emphasizes the intrinsic importance of an individual. He said an apology is the stepping stone to disclosure.
Lucian L. Leape, MD, one of the founders of the National Patient Safety Foundation and author of the 1994 Journal of the American Medical Association article "Error in Medicine," advocated full disclosure as a means of preserving the trust he calls the "cornerstone" of the relationship between the patient and practitioner. He said an apology starts the healing process for both the patient and the practitioner.
"There is not a single study that shows that being honest with a patient makes you more likely to be sued," said Leape. "All the evidence is the other way around."
Leape concurs with Wojcieszak, saying that lawsuits often occur because patients are angry. They are angry not only because something went wrong, but also because of the way the situation was handled. He cites the rise in patient advocacy groups as a testament to the fact patients are unhappy with a system that hides information they desire and demand -- information, Leape said, that is rightfully theirs.
"There is something seriously wrong when a patient has to file a claim," said Leape. "They should never have to file a claim, much less sue."
Richard C. Boothman, JD, chief risk officer for the University of Michigan, offered testimony to the U.S. Senate in 2006 regarding medical justice. He said litigation is often a patient's only recourse for information and answers, adding that the system of waiting for a lawsuit to be filed is backward and ill-conceived. Boothman said patients have a right to information, and hospitals have an obligation to acknowledge mistakes up front.
"People go to lawyers not because they want a million-dollar payout," said Boothman. "People go to lawyers because they want answers and they don't trust their caregivers to give them answers. People go to lawyers because they don't get any information at all."
Boothman said that since 2001, the University of Michigan has successfully implemented its policy on apology and full disclosure. He said they have had a dramatic reduction in claims, they have improved their employee satisfaction rate, and they have used each incidence as a tool for improving clinical safety.
According to Boothman, patients want assurance that something will be done to correct a problem and that it will not happen to someone else. He said openness and honesty lead to safer patient care.
Rita Marie Barsella, RN, BSN, is a freelance writer. To comment on this story, e-mail jboivin@gannetthg.com.
More on The Sorry Works! Coalition
The organization comprises doctors, lawyers, insurers, and patient advocates. The coalitionâs goals include educating medical professionals, lawyers, risk managers, and insurers about medical liability; facilitating progression of the full-disclosure movement; and advocating for legislative activities, such as pilot disclosure programs.
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