0:00

As a practical measure, typically, the first steps

0:03

after an event occurs that needs

0:06

to be disclosed is obviously, uh, you need to, well,

0:10

it's not obvious because so many people are so tense and,

0:13

and, uh, and and fraught after these.

0:16

But of course, you want to attend

0:17

to the patients medical needs.

0:20

You want to notify the key individuals who are involved.

0:25

And many institutions that have communication

0:29

and resolution programs have institutional

0:32

or practice specific protocols that are made available

0:35

to everybody that explains and lays out who gets called

0:39

and what the process should look like in the first 24

0:42

to 48 hours, and then what the process may look like

0:45

and entail in the next weeks and months ahead.

0:50

But of course, the first thing,

0:51

even if it's a delayed diagnosis, is

0:53

to get the patient plugged in to the right care.

0:57

And then also, uh, if an institutional coach is available,

1:01

uh, the coaches could be very helpful in,

1:04

in helping you decide how the communication flows

1:08

and what the communication should look like.

1:12

So typically, uh, the communication follows

1:15

what we know about what patients and families want.

1:19

Uh, uh, after the, uh, uh,

1:21

after preventable adverse events occur.

1:24

Uh, they of course want explicit statements

1:27

that errors occurred.

1:28

They wanna know what happened.

1:30

They wanna know the implications for their health.

1:32

They want to know why it happened,

1:34

how occurrences will be prevented.

1:37

They'll always, of course, want genuine expressions

1:40

of regret and sympathy,

1:41

and when appropriate, they'll want apologies.

1:44

And of course, they'll want just in timely communi

1:46

compensation, particularly when there have been significant

1:49

financial setbacks.

1:51

Now, the conversation where you tell them

1:55

what happened, and apologize may be very different from the

1:59

conversation where any compensation is offered,

2:03

and the personnel may be different,

2:05

but the patients, of course, who are angry

2:07

and upset may not follow that protocol,

2:10

and they may ask you about it, the very first instance.

2:13

And you have to be prepared to kind of discuss it

2:16

with them in a sensitive way to validate their concerns

2:19

and offer supports for them.

2:22

Typically, uh, whether it's a coach or a departmental

2:25

or institutional leader or risk manager,

2:27

typically the preparation for the conversation

2:30

will entail getting together the core information about

2:34

what's known, what's not known,

2:36

what process is already entailed

2:38

for the root cause analysis and the qi.

2:40

And if it isn't complete, what process will go forward,

2:45

uh, in down the line that will then be brought back

2:48

to the patient's families.

2:49

There's very careful consideration of

2:52

who should be in the conversation.

2:54

We know that the patients

2:55

and families often will want the clinicians

2:59

who are most directly involved to talk to them

3:02

and to apologize to them.

3:04

But the patients and families may also want their own

3:07

emotional support,

3:09

and they may want legal counsel in the room,

3:11

particularly when it comes to the compensation offer,

3:13

which can be, uh, difficult.

3:15

Um, but understanding who should be in the conversation

3:19

and then considering the timing

3:21

of the conversation is also a very, uh,

3:24

delicate, uh, matter.

3:26

Should you tell 'em about the, uh, the fact

3:29

that there was an error involved when there in the immediate

3:32

acute crisis situation?

3:34

Or should you wait?

3:36

What, what do you do in a situation when, uh,

3:38

the care is delayed?

3:40

Getting them plugged into the care that they need may

3:44

not be the best time to tell them that also,

3:46

that an error has taken place,

3:48

but there is a trickiness to waiting, uh,

3:51

and delaying that piece of conversation also.

3:54

And then, of course, if a patient has died

3:56

and the family doesn't know about an error, bring

3:59

that error to them.

4:00

Uh, at later can be a very difficult, uh, process

4:05

and requires a lot of thoughtful consideration.

4:09

There has to be, uh, there optimally, uh,

4:12

careful consideration of

4:14

what the actual conversation is going to look like as soon

4:17

as you walk in the door.

4:19

How's the seating gonna work?

4:20

Who is gonna initiate the conversation?

4:23

Who is gonna convey what information?

4:25

It is important to plan the conversation as much as you can

4:29

and anticipate the questions and emotions as best possible.

4:33

Anticipating the questions

4:35

and emotions is not so hard to anticipate.

4:41

Figuring out how to respond, particularly in the heat

4:44

Of the moment where there

4:45

May be extraordinary anger coming at you,

4:49

that is a very difficult, uh, matter

4:52

and often will be, uh, helped by having the individuals

4:56

who are going into the conversation use role play

4:59

to game it out

5:00

and to work on the potential answers that may,

5:05

Uh, may be optimal.

5:07

You wanna be prepared with follow

5:09

Up with regarding for, uh, to

5:11

Contacts for the patients and families, their supports,

5:15

Emotionally, Chaplain for chaplaincy or

5:18

Financial financially, uh,

5:20

what additional information they may need.

5:23

And issues about compensation,

5:26

Which you may not be prepared

5:27

For, uh, in terms of, uh, the actual details.

5:31

But you can Refer 'em to, uh,

5:33

various people in the hospital who may help them with that.

5:35

And then, of course, uh, you wanna, uh, convey, uh, you want

5:39

to have an understanding of who is available in the hospital

5:42

to support the clinicians.