Some organizations are seeing bad outcome disclosure as a multi-step process of communication that evolves over many days or weeks, not just one conversation. First, few people remember details from the first conversation. Second, information about event may come in stages. Third, the family may have questions days or weeks after the initial conversation.
Gallagher says some hospitals will follow-up a verbal conversation with a written synopsis.
7. "I'm Sorry" Laws
This month Pennsylvania joined 30 other states with laws precluding a doctor's apology for a medical error or adverse event from being used to bolster a plaintiff's case in court. At least one study has shown that a policy of apologizing for medical errors leads to lower costs for healthcare organizations and does not invite malpractice suits.
Gallagher says there are still obstacles to appropriate adverse event disclosure. Frontline healthcare workers "generally don't have confidence that if they report an adverse event, it won't be held against them. That's a major impediment to getting people to report."
And, of course, that blocks any recognition that the outcome was related to an error that could have been prevented.
But overall, he says, change is well underway. "We're at the end of the beginning," he says, "just starting to see meaningful headway to assure that disclosure is the norm rather than the exception. And with the advent of some programs and national dissemination, I hope we'll see much faster progress over the next few years."