I applaud the growing number of hospitals that are apologizing for medical errors rather than trying to cover them up or hoping the patient never realizes a mistake occurred. Yet I can't help but wonder what impact this practice will have on small community hospitals.
Apology and medical-error disclosure policies are becoming more common in hospitals as a way to reduce medical malpractice costs. The thinking is that by establishing open communication that encourages admitting medical errors up front, suggesting a reasonable settlement, and offering an apology can help limit hospitals' exposure to large monetary judgments—and the costs associated with trial litigation.
However, one bad outcome is often reason enough for members of the community to boycott their local facility for the larger hospital or academic medical center up the road—even if it isn't the hospital's fault. So how will the community react if the hospital is actually to blame for an error? I can hear the conversation already. "Oh, don't go there. Did you hear what happened to Betty? They gave her the wrong medication."
Many small hospitals are already perceived by their community as a Band-Aid station to be used only for routine procedures or in the case of a dire emergency. Sometimes not even an emergency can convince members of the community to go to the local hospital. Some people would rather drive 40 minutes to a larger facility even while experiencing heart attack symptoms.
This is not to say that hospital size is an indication of quality. Just because a facility is larger doesn't mean it is error-proof. I know this, and you know this. But does your community? Many small-town hospitals are fighting against the perception that "bigger is better." So if the local hospital admits that it gave a patient the wrong medication or almost gave the wrong patient a cardiac catheterization, will members of the community voluntarily seek treatment at that hospital again? Or will they go to a larger facility that they perceive offers a higher level of care?
I'm not sure how your community will respond to a medical-error disclosure policy. I do think people will appreciate the fact that their local hospital did the right thing in admitting the error—especially if the hospital communicates how it will prevent similar errors from occurring in the future. And that may be where small-town hospitals have an advantage over their larger counterparts.
Rural hospitals' smaller size and reduced complexity can enable them to examine patient safety and medical errors issues—and implement process improvements—more quickly than their large urban counterparts, which often have more levels of bureaucracy that can hinder rapid change. In addition, a study by the University of Minnesota Rural Health Research Center found that the organizational structure of urban hospitals, which have many different types of specialist physicians, nurses, and technicians with a high volume of information flowing between them, can lead to a higher proportion of adverse events than in a rural facility, where one of the main risks is that the relationship between its physicians, nurses, and technicians may lead to informal communication that is not always completed accurately.
Hopefully, explaining how your hospital has remedied or plans to remedy its processes to prevent errors from occurring in the future will be enough to build trust with the members of your community—and perhaps most importantly, keep them walking through your front door.
Carrie Vaughan is editor of HealthLeaders Media Community and Rural Hospital Weekly. She can be reached at firstname.lastname@example.org.
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