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September 40th, 2007 NEWSLETTER
Doug Wojcieszak, Founder & Spokesperson
Contact phone/e-mail address: 618-559-8168; doug@sorryworks.net
THIS WEEK'S EDITION:
- Sorry Works! coming to an area near you?
- Column from Med-Mal Mediators
- How to Apologize to Patients and Families After Medical Mistakes
- Apology and Yom Kipur
SORRY WORKS! COMING TO AN AREA NEAR YOU?
Sorry Works! spokesperson Doug Wojcieszak is hitting the road this fall to make several presentations on disclosure and apology. If possible, he would like to make additional presentations to hospitals, medical organizations, or insurers in a region. If you are located near one of the following presentation sites and would like to have a Sorry Works! presentation for your hospital or insurer, please e- mail doug@sorryworks.net or call 618-559-8168:
- Pittsburgh area, October 11th
- Iowa City, Iowa, October 19th
- Las Vegas, October 20th
- Omaha, Nebraska, October 29th
- New York City, November 14th
- Louisville, KY, November 15th
- Ft. Bragg, North Carolina, December 12th.
If you are not near one of these presentation sites and still would like to have a Sorry Works! presentation for your hospital, medical organization, or insurer e-mail doug@sorryworks.net or call 618-559- 8168. Thank you!
COLUMN FROM MED-MAL MEDIATORS
In a recent newsletter we published a letter to the editor from Rush University Medical Center which highlighted their disclosure and mediation program. Mediation can be an important part of the disclosure process, especially when compensation is due to the patient/family.
Following up on the Rush piece is a column below submitted by Chris Stern Hyman and Carol Liebman. Chris and Carol are both attorneys who have extensive experience in the medical malpractice arena. Chris is a partner in the Medical Mediation Group and Carol is a Professor of Law at Columbia University. We hope you enjoy their column!
Disclosure, Apology and Mediation
For several years Carol Liebman, Clinical Professor at Columbia University School of Law, and Chris Stern Hyman, Associate Research Scholar at the law school and founder of Medical Mediation Group, have been working with hospitals and health care organizations to encourage increased disclosure of adverse events (that is both medical errors and unanticipated outcomes), apology when appropriate, and mediation of pending medical malpractice lawsuits.
In discussing their work, Chris and Carol write, "All three of these steps - disclosure, apology, and mediation - can be daunting for health care providers, insurance representatives, and hospital administrators faced with a medical error or adverse event. Mediation that requires a shift from aggressive advocacy to collaborative advocacy also can be daunting to lawyers. We have two recommendations that might help.
One is for health care facilities to create an in-house consultation service of skilled staff members who can help physicians and other members of the health care team prepare for a disclosure conversation, participate in the conversation if necessary, and debrief the health care providers after the conversation. The disclosure consults should be experienced staff who have mastered the communication skills necessary to help others plan disclosure conversations; decide who should attend and what will be said; and consider whether to apologize and, if so, whether to make a full or partial apology. These skilled experts can also help their colleagues anticipate the questions patients and family members are likely to ask and can follow-up with both the patient or family and members of the medical team. Debriefing permits a discussion of ways to avoid similar errors as well as an opportunity to provide emotional support to health care providers struggling with guilt or shame.
The other recommendation is to use mediation as soon as possible after an error to resolve both potential claims and pending medical malpractice lawsuits. The discussion in the recent newsletter about the Rush Mediation Program describes one successful model. We advocate a model of mediation that maximizes the opportunities for a full and frank discussion among those most effected by the error or adverse event in which questions, which may be important to the patient or family member but may not be relevant to a legal claim, can be answered and opportunities to avoid a repeat of the harm are considered. We use experienced co-mediators, who are lawyers with health care expertise. We have found the presence and participation of the patient and/or family member in the mediation are key elements of success. Frequently an agreement, which seemed unobtainable at the beginning of the mediation, becomes possible when patients and family members obtain information that helps them understand what happened, have the opportunity to describe the emotional impact of the adverse event, and have their feelings acknowledged. Also, having a health care provider participate in the mediation can be extremely effective in restoring trust.
In New York we are studying mediation with the hope that empirical data may encourage more clients, lawyers, and insurers to use the process to resolve med mal cases. In 2004 Chris conducted a study of mediation of medical malpractice lawsuits filed against New York City Health and Hospitals Corporation facilities with some interesting results. Plaintiffs participated in 16 of the 19 mediations and 13 of the 19 settled. Plaintiffs, their attorneys and the defense attorney were satisfied with the process whether or not settlement was reached. Apology was associated with settlement and 68% of the cases settled within an average of 2 1/2 hours. Currently Carol and Chris are conducting a similar but larger study for private hospitals in New York City which will be completed by 2008.
Articles about our recommendations and the completed New York City mediation study are:
C.B. Liebman and C.S. Hyman, "A Mediation Skills Model to Manage Disclosure of Errors and Adverse Events to Patients," Health Affairs 23, no.4 (2004): 22-32.
C.S. Hyman and C.B. Schechter, "Mediating Medical Malpractice Lawsuits Against Hospitals: New York City's Pilot Project" Health Affairs, 25, no. 5 (2006):1394-1399.
HOW TO APOLOGIZE TO PATIENTS AND FAMILIES AFTER MEDICAL MISTAKES
At 1pm EST on Tuesday, October 9th Sorry Works! spokesperson Doug Wojcieszak will be hosting a webinar on how to apologize to patients and families after medical mistakes. This will be a valuable program for medical and insurance professionals who are developing disclosure programs.
For registration information, e-mail editor@complianceonline.com or call 1-650-620-3937.
APOLOGY AND YOM KIPPUR
Below is a contribution sent to us from a Jewish supporter of Sorry Works! in Cincinnati, OH. The Jewish Holiday of Yom Kippur was this past weekend, and the column below about the holiday and its emphasis on apology and atonement has a powerful message for Sorry Works! readers. Most importantly, the column emphasizes the importance of seeking out people we have wronged (pro-active apology) and the healing power of apology, especially for relationships. This column is definitely worth passing on to friends and colleagues and posting in the doctors' lounge.
Lost opportunities on Yom Kippur Eve
What I know about saying "Sorry"
By Jonathan Rosenblum
http://www.JewishWorldReview.com
Of all the silly sentences produced by American pop culture, my personal choice for silliest is Erich Segal's, "Love means never having to say you're sorry." (Who but a Yale professor could have written something so dumb?) "Love means always being prepared to say you are sorry," is far sounder advice to newlyweds.
Certainly, the Torah places a high premium on the willingness to seek forgiveness from both G-d and man. Verbal confession is one of the essential elements of repentance. And Maimonides, in his Laws of Repentance, teaches that on Yom Kippur G-d will not forgive our sins against our fellow man until we have made restitution and received his forgiveness. Thus the custom of requesting mechillah (forgiveness) as Yom Kippur approaches.
Neither admitting that we have wronged someone else or seeking his forgiveness comes easily to most of us. Who has not experienced holding a phone in the air while trying to summon up the courage to make an uncomfortable phone call to someone we have injured? And usually the receiver is replaced with the call still unmade.
Even with loved ones, whom we can be pretty confident of having recently injured, we tend to put off our requests for forgiveness to late on Erev (eve of) Yom Kippur. The lateness of the hour leaves less time to dwell on unpleasant details. But it also provides none of the purgative power of a serious request for forgiveness, with all the soul-searching entailed.
In recent years, I have been twice privileged to experience how elevated that self-scrutiny can be. One Erev Yom Kippur, I received a call from a rabbi who told me that he had been reviewing the past year, and feared that he had not expressed adequate gratitude to me.
What had I done for him? Almost nothing. I had spent the better part of an evening discussing with him a dispute in which he was involved in a particular institution. After further research, I had written a piece about the situation. But that piece was ultimately not published.
I never told the rabbi about the piece left on the cutting-room floor, and so as far as he knew, I had done nothing to follow up on our conversation. If anything, he would have been entitled to feel that I had let him down. Nor had I felt the slightest bit unappreciated. After our late-night discussion, he had thanked me profusely for my time.
How I made it to his Erev Yom Kippur radar screen, I cannot fathom. But I gained from him some sense of what it means to truly scrutinize one's deeds of the previous year.
LAST YEAR, I received an Erev Yom Kippur call from someone with whom I had a brief, and not terribly pleasant, conversation at least six months earlier. Prior to that, we had exchanged a few Emails, after he wrote me how much he had gained from a biography I had written.
When we found ourselves together at a conference a few months later, I was eager to make a personal connection. At the first break, I introduced myself and mentioned that if he had enjoyed the Rabbi Dessler biography, he would probably enjoy another one as well. I'm no stranger to verbal faux pas, and would be the first to grant that was not the classiest opening line. Still I was taken back by the sharpness of his response: "Don't you have anything else to talk about than the books you have written?"
At that point, I could probably not have recalled my name, much less come up with a grabby new conversation topic, and so I beat a hasty retreat. I spent the next session puzzling over how I had provoked such a response, especially from someone I knew from a number of mutual acquaintances to be both too nice and too classy to cut down strangers for sport. In the end, I consoled myself that nothing had happened: We did not have a relationship before our brief exchange and clearly would not have one in the future. And, at least, no one had overheard our exchange.
With that, I put the matter out of mind. Out of mind, but not forgotten, it turned out, for when he called on Erev Yom Kippur, the memory of our last conversation came rushing back. And that conversation was the subject of his call.
He had not only remembered a 15-second exchange, in the course of a hectic year filled with hundreds of meetings. He had also overcome the temptation to tell himself that there was no point in dredging up an old insult I must surely have forgotten or was too thick to have noticed in the first place.
My first reaction to his request for forgiveness was a feeling of closure on an unpleasant incident. My second was awe at the seriousness with which he approached Yom Kippur.
It turned out that I was wrong about there being no hope of ever establishing a future relationship. With that apology, a completely new page was opened, and we have since spoken at length. Indeed by revealing a depth of character in that I would never have known about had we just spent five minutes exchanging pleasantries, the apology paved the way for a much closer relationship.
I wonder how many other possibly rewarding relationships are lost just because of a failure to utter two simple words — "I'm sorry." Worse, how many of our closest relationships are destroyed, pace Mr. Segal, because of the same failure?
Today, Erev Yom Kippur, is the ideal opportunity to experience the power of confession on both the one seeking forgiveness and the one giving it. The impact is immediate, and not confined to the Heavenly books that will be sealed tomorrow night as our prayers close at Neilah.
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