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September 10th, 2007 NEWSLETTER
Doug Wojcieszak, Founder & Spokesperson
Contact phone/e-mail address: 618-559-8168; doug@sorryworks.net
THIS WEEK'S EDITION:
- Rush Hospital in Chicago discusses disclosure, apology program
- "Is Disclosure Worth The Risk?" Audio Conference a Success
- Question & Answer
RUSH HOSPITAL IN CHICAGO DISCUSSES DISCLOSURE, APOLOGY PROGRAM
Over the past two weeks we have shared exciting information about the University of Illinois Medical Center's disclosure program. This week we share information about another disclosure program also in Chicago: Rush University Medical Center. Rush's program was highlighted in a recent letter to the editor in the Chicago Tribune. See below.
Rush takes a different but interesting twist on disclosure and apology through a mediation program. Hopefully Rush will share more information about their program. What's not clear about their program is will Rush notify a patient/family about a possible error if the patient/family is not aware (like the University of Illinois Medical Center), or does the patient/family have to contact Rush about a possible error than the mediation and disclosure process kicks into action? Clarification is needed, but this approach is still very interesting. Read below and please share with colleagues and friends.
chicagotribune.com
VOICE OF THE PEOPLE (Letters)
Why it is good to 'fess up' to patients
Jerome Lerner, Director, Rush Mediation Center, Rush University Medical Center
August 31, 2007
Judith Graham and the Chicago Tribune are to be commended for bringing to light efforts by hospitals and doctors to admit their mistakes. ("Doctors try new word: Sorry," Page 1, Aug. 19) and editorial ("Give it to us straight, doc," Aug. 23). As you correctly point out, Chicago has become something of a center for the emerging "fess up" movement.
Your readership may also be interested to know that since 1995 Rush University Medical Center has engaged in a program by which it not only acknowledges errors but attempts to fairly compensate patients who may have been injured as a result of those medical errors. The Rush Mediation Program has received national recognition for its unique and effective method of resolving disputes over medical malpractice. It was established out of recognition that some patients may be injured at the hands of otherwise bright, skillful, dedicated and well-meaning health care professionals.
In brief, this program allows the injured patient to select two mediators, who are trial attorneys, to assist the patient and Rush in arriving at a fair and reasonable resolution. One of the mediators is a plaintiff's attorney (a lawyer who represents injured patients against doctors and hospitals) and the other mediator is a defense attorney (a lawyer who defends doctors and hospitals). The patient is allowed to select both mediators. The attorneys who serve in this role are among the very best trial attorneys in theChicago metropolitan area. With their knowledge of medical terminology, rules of evidence and trial strategy, these men and women are uniquely qualified to serve as mediators. Stepping outside of their usual adversarial roles the mediators focus their energies on seeking a common ground of understanding between the parties.
As director of the Rush Mediation Program, I can certainly attest to the program's effectiveness and its preference over taking such disputes to trial. I was a Cook County Circuit Court judge for 18 years and presided over more than 300 trials. . I can tell you that there is no substitute for the parties doing anything more complicated than just sitting down across a table from each other and working out a resolution through honest, civil and straight talk.
An important part of each mediation is when the representative from the Medical Center looks the injured patient squarely in the eyes, accepts full responsibility for the injury the patient has sustained and offers a sincere and heartfelt apology.
The first time that Rush offered such an apology was after a particularly sad case had been mediated and resolved. The case involved a young child who had died as a result of an incorrect dosage of medication being given while the child was in the hospital. The loss of the child was made even worse for the family by the fact that it was the father of the child who insisted on the dosage, which was ultimately administered. Tragically, the father was mistaken and the dosage he insisted be given to his child was almost 10 times what it should have been. Although the family and the hospital arrived at a mutually acceptable monetary compensation through mediation, it was clear that the father remained completely distraught. No amount of money could compensate him for the loss of his child or, it would seem, take away the guilt he felt for the part he had played.
The individuals attending the mediation on behalf of the hospital decided they could not simply walk away. I remember one of them saying, "We failed this family once. Let's not do it again." We all returned to the room where the family remained and explained to the father why this error was not his responsibility but totally that of the hospital. And then we apologized to him for the hospital's error. I can't say that our apology made his grief any easier to bear but we all agreed it was the right thing to do.
Offering a sincere apology has remained an essential part of all mediations conducted by Rush University Medical Center. It may not take away the injury or the loss sustained by the patient, but we know that it is the right, honorable and decent thing to do.
"IS DISCLOSURE WORTH THE RISK?" AUDIO CONFERENCE A SUCCESS
Lee Taft, ethicist and former med-mal plaintiff's attorney, did an excellent job speaking on the audio conference last week, and we had a large, nation-wide audience of hospitals, insurers, and other medical interests for him. CDs of the audio conference are available for sale through RM&PSI. Simply contact Melanie Gober at 517-886-8226 or mgober@rmpsi.com. Thank you to Lee and all those who attended our conference. It was a great sucess.
QUESTION & ANSWER
Time for another installment of "Question & Answer" with Dr. Geri Amori of the Risk Management & Patient Safety Institute and Doug Wojcieszak of The Sorry Works! Coalition.
Question: I apologized and yet the family told their lawyer I never said a word about feeling bad. Why did they lie about me? I feel foolish now.
Geri: Apology is not a single event. In fact, the literature shows that the more serious the offense, the more times we might need to apologize. Please remember that people do not hear well when they are in shock or have been psychologically injured. At an initial disclosure we might apologize for whatever role we may have had in the event. When we return with factual information, we may have to apologize again if we have made an error or caused harm. If the harm is serious, I would expect that we would have to apologize in the next three or four meetings we have with them. Apology, like disclosure, and like consent, are not single events. They are processes. Like all processes, they require attention and time.
I highly recommend several books on apology. My favorites include Aaron Lazare's, "On Apology," Beverly Engel's "The Power of Apology," and Michael Wood's book "Healing Words." There are others as well.
Doug:I think the question speaks to the importance of disclosure training and having a disclosure team. Delivering bad news to a patient or family - especially when there has been an error - is a difficult job. Furthermore, it is not something that medical professionals are hopefully doing on a frequent basis. Therefore, hospitals, medical practices, and insurance companies need to have a team of people from risk, legal, medical, and administration trained on disclosure and apology. These folks really need to understand how to speak in an empathetic, caring fashion without being sucked into arguments or becoming defensive. Training should include plenty of role playing and working through scenarios.
This trained disclosure team will work with doctors and nurses when its time to disclose to a patient and family. The team will either assist the provider or - in some cases - do the disclosure themselves (it ultimately depends on the needs and emotions of the patient/family).
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