|Hospitals Create a Culture of Safety and Trust by Being Transparent About Medical Errors |
By Paul Schyve, MD
Senior Advisor, Healthcare Improvement, The Joint Commission
The complexity of health care creates many opportunities for adverse events, which harm patients and cost hospitals nationwide billions of dollars annually in additional care and malpractice claims. At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of preventable medical errors based on estimates from two major studies, according to the 1999 Institute of Medicine (IOM) report, To Err is Human: Building a Safer Health System.
The IOM report concluded that most medical errors are not caused by reckless individuals but by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them. One of the report’s recommendations is that health care organizations develop a “culture of safety” in which their workforce and processes focus on improving the reliability and safety of care for patients.
A key ingredient of developing a culture of safety is maintaining a sense of trust among the staff within the health care organization and between health care professionals and patients and their families. Patients who have experienced medical errors have consistently said they want health care professionals to inform them when adverse events occur, apologize and show empathy for their suffering, and describe what actions the hospital will take to prevent such events from reoccurring. Patients want also to be treated fairly regarding compensation.
Denial or other defensive strategies can increase the risk of lawsuits because patients feel they are not being treated fairly. Open communication helps to restore the patient’s trust in both health care professionals and the health care organization. The innovations from the University of Michigan Health System and the Veterans Affairs Medical Center (VAMC) adopted a process of full disclosure of medical errors that includes open and honest communication with patients as well as prompt reporting and investigation, and quality improvement initiatives. The results from the VAMC program suggest it reduced overall liability claim costs compared with 35 similar VAMC facilities. It’s important to note that the VAMC is self-insured and individual health care professionals cannot be sued for malpractice, which may have reduced barriers to implementing the full disclosure program.
I suggest that the hospital communicates with patients after an adverse event is reported rather than waiting until an investigation is completed, which can take months. The hospital can do this without having to admit to guilt or blame. The University of Michigan Health System’s risk management committee notifies the patient and/or family after an event is reported in its online system and the details are documented. Patients are promised full disclosure, provided with known facts without speculation, and are informed that a full investigation may take some time.
In addition, patients and families participate in quality improvement initiatives such as rapid response teams. The program has increased medical error reporting and led to fewer malpractice claims and lawsuits.
A hospital’s culture of safety and trust enable staff to report medical errors without fear of blame or punishment. Northwestern Memorial Hospital in Chicago, IL, implemented monthly multidisciplinary patient safety conferences for staff to openly discuss adverse events, which improved staff perceptions of the organization’s safety culture and increased reporting of adverse events. The meetings are moderated by the hospital’s medical director for quality and patient safety. Hospital staff that represent the disciplines involved in the case present and discuss the case and solicit improvement ideas from the multidisciplinary audience. Their feedback is incorporated into quality improvement activities. In addition, a “Good-Catch” award is presented to one or two individuals who caught an error or systems breakdown before it reached the patient.
The fact that hospital staff involved in the adverse events may volunteer to serve on these panels indicates that the hospital has developed a level of trust with staff over time. I suggest that the patient safety conferences consider including patients and/or their families, which can benefit both the health care organizations and the patients who feel that despite their loss due to medical errors, they have contributed to improving the health care system.
Disclosure Statement: Dr. Schyve has not indicated whether he has financial interests or business/professional affiliations relevant to the work described in this profile.
Original publication: June 23, 2010.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: June 19, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.
Date verified by innovator: May 24, 2012.
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