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July 30th, 2007 NEWSLETTER
Doug Wojcieszak, Founder & Spokesperson
Contact phone/e-mail address: 618-559-8168; doug@sorryworks.net
THIS WEEK'S EDITION:
- Another new Sorry Works! speaking engagement...Is your organization interested in a presentation on disclosure?
- Critique of New England Journal of Medicine Article on Disclosure
- Sorry Works! Audio Conference - sign up now
- Interesting New York Times Column on Transparency and Apology in a High Tech World
ANOTHER NEW SORRY WORKS! SPEAKING ENGAGEMENT....IS YOUR ORGANIZATION INTERESTED IN A PRESENTATION ON DISCLOSURE?
Sorry Works! spokesperson Doug Wojcieszak accepted another new speaking engagement this week with a December Grand Rounds presentation to the staff at Womack Army Medical Center in Ft. Bragg, North Carolina. We are pleased and excited about this new presentation, but we want more speaking opportunities 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, e-mail doug@sorryworks.net, or visit this link http://www.sorryworks.net/presentation.phtml for more information. Thank you!
CRITIQUE ON NEW ENGLAND JOURNAL OF MEDICINE ARTICLE ON DISCLOSURE
Approximately a month ago the New England Journal of Medicine released a review article on disclosure written by Dr. Thomas Gallagher, David Studdert, and Dr. Wendy Levinson. Some of you may remember David Studdert who was the lead author on the Health Affairs article on disclosure that was widely panned for being a poorly concocted study. Studdert's colleagues from Australia had the most critical words for him and his co-authors in a letter to Health Affairs.
Well, Studdert and a different group of co-authors do a better job with this article, however, he and his co-authors didn't hit the nail completely on the head.
The Good Points:
There are many good points and observations in the article, which we will highlight here:
- Several times the authors mentioned how the environment is ripe for change and disclosure is going to be the norm in the next decade for the majority of healthcare institiutions in the States and world-wide as well.
- The article mentions major progress for disclosure in Australia, the United Kingdon, and Canada. The article also correctly points out that the Australian national disclosure standard clearly instructs providers not to admit liability, which is a big problem for their standards which must be corrected. Kinda hard to say "sorry" and sound like you mean it if you can't take ownership of the mistake. Such "apologies" are laden with weasel words which, in most cases, increase anger with customers.
- The article does a nice job of explaining the National Quality Forum's guidelines on disclosure and how these guidelines, which are followed by Leapfrog and their member companies, will push many healthcare institutions to develop sophisticated disclosure programs. Great and promising observation.
- The article cites interesting statistics about risk managers. In 2002, risk managers said 36% of healthcare institutions had established disclosure policies, but in 2005 that number jumped to 69% of institutions had developed disclosure policies. This data corresponds with the response and interest Sorry Works! receives from risk managers at conferences and meetings. Most risk managers embrace disclosure....especially risk managers who started their careers as nurses. Risk managers are great allies to the disclosure movement and Sorry Works!
- The authors emphasized that disclosure cannot be conducted in a "cookbook" (their words) fashion with a one-size fits all approach. Each disclosure situation is unique and must be handled by trained professionals. We agree.
- The article makes a good point of mentioning the need for training on disclosure for providers and staff, and the need for highly trained disclosure teams to admister a disclosure program.
- The final good point: The article says "disclosure initiatives are likely to be those that emerge locally, are driven by an institutional leadership and workforce committed to transparency, and focus on providing health care workers with the skills needed to conduct these difficult conversations." This is an excellent observation and matches with the history of the disclosure movement. Bravo!
The Bad Points:
There are several statements and passages in the article that are out-of-bounds and show that Studdert and his colleagues still have much to learn about disclosure.
- The article states that "disclosure will not have the chilling effect on litigation that some advocates have claimed." How can they say this...how do they know this? The article offers no evidence, just speculation, and this statement flies in the face of data and stories from the field which show the contrary: lawsuits and litigation expenses decrease when disclosure and apology are practiced in a programatic fashion.
- The article makes the following point about the disclosure programs at the Lexington VA and the University of Michigan: "...the generalizability of the results at a single Veterans Affairs hospital and a single academic institution is questionable." The problem with this statement is that institutions that are starting to follow the VA/UM approach are achieving the same results: fewer lawsuits, reduction in the size of settlements, and lower litigation expenes. If you keep patients and families from getting angry and work with them to solve problems in a pro-active fashion lawsuits will lessen. You don't need a research program to prove this point - just common sense.
- The article discusses how some apology laws have "holes," meaning that admissions of fault are not covered, and regardless of the holes plaintiffs attorneys may use information from disclosure events, whether the information is admissable or not. Studdert and his co-authors should have added a quality defense attorney to their writing guild. The attorney would have said "So what?!" about this point. Apology laws are legal nothings and if disclosure is done right it will strengthen - not weaken - a case.
The authors also said apology laws will have little impact on disclosure behavior. Again, they miss the point on apology laws. We have seen in states such as South Carolina where an apology law can increase interest in disclosure. The University of Illinois Medical Center cited Illinois' apology law as a help in getting their program off the ground. Indeed, these apology laws - while legal nothings - have good PR value. They make providers feel more comfortable about apology and disclosure. Please understand: You don't need an apology law to start a disclosure program. Look at the University of Michigan's program - no apology law in the Wolverine yet they have the most robust program in the states. Nonetheless, an apology law can make it easier to implement disclosure.
- In discussing COPIC's disclosure program, the authors make the following statement: "Colorado has enacted broad tort reform that provides a fertile environment for the 3Rs program." The authors show they are stuck in the old paradigm which says the med-mal crisis is a legal problem. Disclosure can work anywhere, especially in litigation hot beds. Providers need to forget about the state house and the courts and focus on their customers (patients and families). Indeed, if the politicians, courts and trial bar are hostile all the more reason to make sure your customers don't leave your facility angry. If anything, litigious regions are the most fertile areas for the development of disclosure programs.
Concluding Thoughts:
This article will provide more exposure and emphasis on disclosure, which is good. It adds to the drumbeat for disclosure, which is growing louder and louder. Good. The authors make several excellent observations, however, they hold onto some old and incorrect thoughts. Surely with time and persistent educational effort we will help folks, including these authors, to let go of this antinquated thinking.
SORRY WORKS! AUDIO CONFERENCE - REGISTER NOW
On September 5th at 1 PM EST Sorry Works! and the Risk Management & Patient Safety Institute will host an advanced disclosure conference with Lee Taft, ethicist and former med-mal plaintiffâs attorney. The title of the audio conference is "Disclosure: Is it worth the risk?" In short, this audio conference will examine and evaluate the risks of disclosure - especially those that are coupled with authentic apology - from the perspective of a person who used to represent those injured by medical error and who now designs and implements disclosure programs for hospitals.
For twenty years Lee Taft worked as a dually board certified trial lawyer. He came to realize that even when the injured party recovered a favorable verdict or settlement, justice was often incomplete. This point was driven home after Taft successfully prosecuted a case on behalf of a young woman with small children. Her husband died as a result of preventable, medical errors. None of the physicians ever accepted responsibility for the errors that led to her husband's death. If they had, she said she could heal. Yet, accepting responsibility carries significant institutional and personal risk. Taft's work bridges the gap between patients' desires and providers' fears.
Taft now has a national consulting practice in which he implements disclosure programs - writing disclosure policies, educating from the board room to the floor nurse, and working with risk managers and defense lawyers in the wake of error by embedding disclosure into litigation strategy. While he is a proponent of apology in some disclosure contexts, you will quickly learn his approach is not pollyannish.
In this program Taft will identify risks disclosure creates and show you how to evaluate and avoid those risks. This program will bring disclosure theory into practice, a "can't miss" event for all those struggling to make disclosure a reality in their institutions.
The conference will be hosted by Dr. Geri Amori of RM&PSI.
The cost for the audio conference is $199. The conference will count for CME/CEU credits. To register today, please contact Melanie Gober of RM&PSI at 517-886-8226 or mgober@rmpsi.com. For additional information including a brochure on the conference please visit this link:
http://www.sorryworks.net/pdf/Web_Brochure_CME.pdf
Sorry Works! is pleased to partner with RM&PSI to bring such a high- quality program to our readers. We hope you will join us at 1pm EST on September 5th.
INTERESTING NEW YORK TIMES COLUMN ON TRANSPARENCY AND APOLOGY IN A HIGH TECH WORLD
Below is an interesting column that recently ran in the New York Times. The University of Michigan's Disclosure Program is mentioned in the article. Be sure to share this column with friends and pass along to colleagues. The article emphasizes how important it is to maintain positive relationships with customers - especially after something goes wrong - in this high tech age. Indeed, everyone of your customers can be a reporter who shares good or bad information about your institution to a large audience with speed and ease. Think about it...a patient/family (customer) suffers an adverse event at your institution then faces deny and defend risk management, only to go home, hop on the computer and tell thousands of people throughout the region that your hospital is a band-aid station with the click of a button. Getting a visit from a process server might be the least of your worries! Read below.
The New York Times
June 27, 2007
Op-Ed Columnist
The Whole World Is Watching
By THOMAS L. FRIEDMAN
Three years ago, I was catching a plane at Boston's Logan airport and went to buy some magazines for the flight. As I approached the cash register, a woman coming from another direction got there just behind me - I thought. But when I put my money down to pay, the woman said in a very loud voice: "Excuse me! I was here first!" And then she fixed me with a piercing stare that said: "I know who you are." I said I was very sorry, even though I was clearly there first.
If that happened today, I would have had a very different reaction. I would have said: "Miss, I'm so sorry. I am entirely in the wrong. Please, go ahead. And can I buy your magazines for you? May I buy your lunch? Can I shine your shoes?"
Why? Because I'd be thinking there is some chance this woman has a blog or a camera in her cellphone and could, if she so chose, tell the whole world about our encounter - entirely from her perspective - and my utterly rude, boorish, arrogant, thinks-he-can-butt-in-line behavior. Yikes!
When everyone has a blog, a MySpace page or Facebook entry, everyone is a publisher. When everyone has a cellphone with a camera in it, everyone is a paparazzo. When everyone can upload video on YouTube, everyone is filmmaker. When everyone is a publisher, paparazzo or filmmaker, everyone else is a public figure. We're all public figures now. The blogosphere has made the global discussion so much richer - and each of us so much more transparent.
The implications of all this are the subject of a new book by Dov Seidman, founder and C.E.O. of LRN, a business ethics company. His book is simply called "How." Because Seidman's simple thesis is that in this transparent world "how" you live your life and "how" you conduct your business matters more than ever, because so many people can now see into what you do and tell so many other people about it on their own without any editor. To win now, he argues, you have to turn these new conditions to your advantage.
For young people, writes Seidman, this means understanding that your reputation in life is going to get set in stone so much earlier. More and more of what you say or do or write will end up as a digital fingerprint that never gets erased. Our generation got to screw up and none of those screw-ups appeared on our first job resume's, which we got to write. For this generation, much of what they say, do or write will be preserved online forever. Before employers even read their resume's, they'll Google them.
"The persistence of memory in electronic form makes second chances harder to come by," writes Seidman. "In the information age, life has no chapters or closets; you can leave nothing behind, and you have nowhere to hide your skeletons. Your past is your present." So the only way to get ahead in life will be by getting your "hows" right.
Ditto in business. Companies that get their hows wrong won't be able to just hire a P.R. firm to clean up the mess by a taking a couple of reporters to lunch - not when everyone is a reporter and can talk back and be heard globally.
But this also creates opportunities. Today "what" you make is quickly copied and sold by everyone. But "how" you engage your customers, "how" you keep your promises and "how" you collaborate with partners â that's not so easy to copy, and that is where companies can now really differentiate themselves.
"When it comes to human conduct there is tremendous variation, and where a broad spectrum of variation exists, opportunity exists," writes Seidman. "The tapestry of human behavior is so varied, so rich and so global that it presents a rare opportunity, the opportunity to outbehave the competition."
How can you outbehave your competition? In Michigan, Seidman writes, one hospital taught its doctors to apologize when they make mistakes, and dramatically cut their malpractice claims. In Texas, a large auto dealership allowed every mechanic to spend freely whatever company money was necessary to do the job right, and saw their costs actually decline while customer satisfaction improved. A New York street doughnut-seller trusted his customers to make their own change and found he could serve more people faster and build the loyalty that keeps them coming back.
"We do not live in glass houses (houses have walls); we live on glass microscope slides ... visible and exposed to all," he writes. So whether you're selling cars or newspapers (or just buying one at the newsstand), get your hows right - how you build trust, how you collaborate, how you lead and how you say you're sorry. More people than ever will know about it when you do or don't.
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