Massachusetts hospitals launch patient apology program

The initiative, aimed at reducing liability claims, is similar to disclosure efforts at academic medical centers in Michigan and California.

By — Posted May 21, 2012

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Seven Massachusetts hospitals have joined forces to implement an “I’m sorry” policy to improve transparency and reduce medical liability lawsuits.

The program — Disclosure, Apology and Offer — was modeled after a similar effort at the University of Michigan Health Care System and will start sometime in 2012. Each hospital will begin the program on its own at undetermined dates.

The new initiative is a fundamental shift from the culture of blame and denial that plagues the medical liability system, said Alan Woodward, MD, chair of the Massachusetts Medical Society’s Committee on Professional Liability and a past MMS president. The medical society is part of a statewide health care coalition launching the effort.

“Right now, it’s a very reactive system. We’re trying to swap that with a system that is very proactive and advocates for the health care needs of patients,” he said. The new approach will “provide supportive assistance to physicians and patients instead of isolating them [and enable] physicians to practice evidence [-based] medicine rather than defensive medicine.”

Under the plan, health professionals and institutions will disclose to patients when an adverse outcome occurs. When appropriate, staff will apologize for the event and offer fair financial compensation. Patients can still sue if they want.

The Massachusetts hospitals participating in the initiative are:

  • Beth Israel Deaconess Medical Center in Boston.
  • Beth Israel Deaconess Hospital in Needham.
  • Beth Israel Deaconess Hospital in Milton.
  • Baystate Medical Center in Springfield.
  • Baystate Franklin Medical Center in Greenfield.
  • Baystate Mary Lane Hospital in Ware.
  • Massachusetts General Hospital in Boston.

The program not only will resolve negligence accusations more quickly, it also will help improve patient safety, said Paula Griswold, executive director of the Massachusetts Coalition for the Prevention of Medical Errors, a public-private partnership that advocates patient safety. The group is part of the statewide health care coalition. A more communicative environment encourages doctors to discuss near-misses related to adverse events, thus preventing incidents, Griswold said.

“In the current system, there’s less openness about how errors occur,” she said. Disclosure programs provide “a safer environment where if something happens, [doctors] don’t feel they are going to be blamed personally. They [are] more open to discussing. That information is used by the organization not just to compensate, but to change how care [is delivered].”

Similar programs illustrate success

Efforts to reform the state’s medical liability system started in 2010, when medical society leaders and Beth Israel Deaconess Medical Center received a planning grant from the Agency for Healthcare Research and Quality. The grant was part of President Obama’s Patient Safety and Medical Liability Initiative.

Hospital and physician leaders spent a year researching how best to implement a disclosure program, interviewing stakeholders and reviewing other medical liability programs. The University of Michigan program was among those studied. Since instituting its apology program, the school says it has cut litigation costs by $2 million a year, and medical liability claims have fallen by 40%.

Stanford University’s hospitals and clinics have saved $3.2 million in annual premiums since establishing a similar program, according to an Institute for Healthcare Improvement report released in October 2011.

“We are impressed with the evidence coming out of the University of Michigan and Stanford that suggests they have achieved a more satisfying experience for patients and providers, and lowered costs,” said Kenneth Sands, MD, senior vice president for Health Care Quality at Beth Israel Deaconess Medical Center.

Though the grant helped with the program’s development, implementation of the initiative is being funded by grants from the state’s three largest health insurers, including Blue Cross Blue Shield of Massachusetts. The coalition would not reveal the amount of the grants.

Launching an “I’m sorry” initiative is not without issues. Dr. Sands said some physicians probably will be hesitant to openly discuss adverse events with patients. Some have been taught to do the opposite.

“There’s a challenge related to this being unfamiliar territory for physicians,” he said. “They’ve never learned how to do this, so there’s not a comfort zone.” But, he added, other programs have shown that “physicians are comfortable once they’ve learned about it.”

As part of the program, each hospital will have a mentor available to physicians at the time of an adverse event, Dr. Woodward said. The mentor will support medical staff as they go through the disclosure process and discuss with clinicians any concerns they may have.

“We know that an apology is therapeutic on both sides,” Dr. Woodward said. “We know that it’s very healing. What would you want if you were injured? I would want full disclosure. I would want somebody to tell me what happened, what it means to me medically and what they are going to do to prevent a reoccurrence.”

American Medical Association Council on Ethical and Judicial Affairs policy states that when a doctor makes a medical error, “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.

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