Majority of hospitals slow to adopt routine apology policy

With 30 states now boasting laws that make apologies after adverse events inadmissible in court, more hospitals are examining whether to add apology to their protocols.

More than 100 physicians and hospital officials gathered for a two-day Joint Commission seminar last month exploring the benefits, and challenges, of saying, "We're sorry."

The march toward routine apology and disclosure when things go wrong has been slow.

Steve Kraman, MD, the former chief of staff at the Veterans Affairs Medical Center in Lexington, Ky., who spearheaded a policy there, said the issue of whether saying sorry can reduce costs is being overanalyzed.

"It's the right thing to do," Dr. Kraman said. "That's it."

More hospitals are experimenting with the apology-and-disclosure concept but "have not openly adopted it," he said. "Many hospitals still see this as the bleeding edge of the movement."

The Lexington VA decided in 1987 that it would investigate adverse events, disclose the results to patients, and apologize and offer compensation when harmful errors were committed. After positive results, the VA system adopted the Lexington policy.

In 2002, the University of Michigan Health System adopted a similar policy and says it is saving $2 million a year in medical liability costs. The Stanford University Medical Center, Harvard's 16 teaching hospitals, the 42-hospital Catholic Healthcare West system, Kaiser Permanente's 30 medical centers and Children's Hospitals and Clinics of Minnesota also have adopted apology-and-disclosure policies.

These measures usually call for immediately disclosing an adverse event and expressing regret or a generic "We're sorry this happened" if it's still unclear why things went wrong. Hospitals follow up with patients and families to disclose the results of their investigation, apologize if a personal or systems error occurred, and commit to making changes to prevent future mistakes.

The Joint Commission requires disclosure to patients in sentinel events cases, and AMA ethical opinion states that when a doctor errs "the physician is ethically required to inform the patient of all the facts necessary to ensure understanding of what has occurred" and that liability concerns should not impede disclosure.

Still, the vast majority of hospitals and insurers have resisted apology-and-disclosure policies, worried that such transparency could give more ammunition to the plaintiffs' bar to pursue frivolous lawsuits.

Even when hospitals, insurers and lawyers don't restrain physicians from being open with patients or expressing regret, many doctors find the process incredibly difficult due to lack of training and the emotional toll.

"We all spend time breaking bad news," said Albert Wu, MD, MPH, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health who lectures medical students and physicians across the country on how to disclose errors. "It's a normal part of physician-patient dialogue. But this is a special kind of bad news."