0:00

So these apology and disclosure programs are formally

0:03

known as com Communication and Resolution Programs.

0:08

They, these have been around now for, uh,

0:10

two decades or more.

0:13

They feature prompt identification

0:15

and medical injuries in early event reporting,

0:17

timely competence, compassionate disclosure

0:20

and explanations to the patient's families about the errors

0:24

and adverse events, apologies when appropriate,

0:28

all proactive offers of compensation when appropriate,

0:33

aggressive defense against the liability claims

0:39

when the case is without merit.

0:41

And then very importantly, incorporation

0:44

of the lessons into the quality

0:46

and safety improvement programs,

0:49

and incorporating the voices of the patients

0:52

and families involved to help figure out solutions

0:55

to mitigate the likelihood of future occurrences.

0:59

It's important to note

1:00

that this is not just a one-time conversation,

1:03

but it's a complex, multi-step, multi-state holder process.

1:09

The timely and compassionate disclosure of the explanations

1:12

and the apologies may come at a very different time than any

1:17

offer of compensation, which occurs

1:19

after there's been significant adjudication

1:22

of the issue throughout the institution.

1:26

Now, there are well over 200 hospitals

1:29

and institutions now that have formal communication

1:31

and resolution programs.

1:33

Thus far, none has reported negative financial impacts

1:37

of having instituted the program,

1:39

and some large programs have reported favorable outcomes

1:44

with regard to their overall malpractice costs.

1:48

Michigan, for example, has, which is perhaps the best known

1:51

and well, uh, reported of these programs,

1:54

has reported decreased claims lawsuits, time to resolution,

1:59

which benefits both the patients

2:01

and the institution, total liability costs,

2:04

total patient compensation,

2:06

and non-compensation related expenses.

2:09

It's important to note that Michigan is in

2:12

a partial apology law state.

2:15

Some institutions have reported some systems improvements,

2:19

but it is a very important caveat to offer that most

2:23

of these programs have been, uh,

2:27

de described in large self-insured

2:30

and often academic healthcare organizations

2:33

that have single risk managers, single insurers.

2:37

It may not, at least at present work as well say,

2:40

for private practices

2:42

where there may be multiple risk managers

2:44

or multiple insurers involved.

2:46

An important thing to remember, these

2:52

con communication and resolution programs are

2:56

large institution-wide

2:59

Systems that take a lot to get off the ground.

3:02

They require gap analysis within the institutions to see

3:06

where the readiness is and what needs to be bolstered.

3:10

Robust event reporting systems,

3:12

understanding within the institution of how human behavior,

3:17

technology and systems often collude

3:19

to create adverse events and errors.

3:22

Cultures that recognize that we are all human,

3:26

that use these, uh, adverse events

3:28

and errors as opportunities for learning.

3:31

And not to use these as opportunities to shame

3:34

and blame the people involved.

3:36

There needs to be, uh, cooperation

3:38

and coordination between pa, patient relations, quality,

3:41

safety insurers, risk managers that need

3:46

to be systems for the, uh, that provide emotional

3:49

and financial support for the patient's families,

3:52

emotional support, either internally

3:54

or externally for the medical personnel who are involved.

3:58

And then many

3:59

of them will offer concerted communication training

4:03

for the very difficult communication

4:04

that they're asking the p providers to enter into.

4:08

And the provision of coaches, cohorts of individuals

4:12

who are well practiced in the communication

4:15

and understand all of the, uh, issues involved

4:18

who can be available in a just in time 24 7 basis.

4:22

For those individuals who are, uh, have situations

4:27

where they need to communicate with patients

4:29

and families about errors

4:31

and adverse events, either immediately

4:33

or even in a delayed fashion three,

4:35

six months or a year later.

4:40

One of the important aspects of the successful, uh,

4:44

implementation of these systems is that they are articulated

4:48

as an institutional leadership priority, uh, where honesty

4:53

and transparency is

4:55

after harm is articulated

4:56

as integral to the clinical mission.

4:59

They're not merely a claims management me mechanism,

5:02

but rather decide to enhance the patient

5:05

and provider experiences, patient safety and peer learning.

5:08

And they sometimes may lower liability

5:13

and defense costs.