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Medical Apology Strategy Shows Signs of Strength

 |  By jcantlupe@healthleadersmedia.com  
   May 03, 2012

I'm just starting this column and already I'm saying, "I'm sorry."

A year ago, I wrote how the University of Michigan Health System found it extremely worthwhile in cost savings and patient satisfaction when physicians apologized for doing something wrong.

I'm bringing it up again, and I'm sorry for repeating myself, but there's much more to say about this now.

In medical cases, apologies don't make the malpractice issue go away, nor do they necessarily prevent such litigation.  I'm writing about this simple practice again because other, similar efforts are worth spotlighting in their attempts to reduce malpractice litigation, not only through scattered health systems across the country, but on a statewide stage.

For instance, the Massachusetts Medical Society last month announced plans for a pilot program involving hospitals, physicians, academics and insurers to use an approach of "Disclosure, Apology and Offer" to reform the medical liability system in the Bay State. 

The DA&O refers to when physicians admit mistakes, offer an apology, and potentially offer to settle the issue, not necessarily in court. The program was initiated after the society released a report, Roadmap to Reform, which focused on exploring alternative approaches to the existing tort system involving medical liability.

The society and the Beth Israel Deaconess Medical Center received a grant from the Agency for Healthcare Research and Quality to undertake a three-year pilot of this initiative.

The seven hospitals participating in the program include three from the Beth Israel Deaconess Medical Center system, based in Boston, three from the Baystate Health System in Springfield, MA; and Massachusetts General Hospital.

 "We're proposing a fundamental transformation of the medical liability system to use the courts as a last resort," says Alan Woodward, MD, past president of the Massachusetts Medical Society, who is involved in the project. "We know the current liability system is driving unnecessary costs in the form of defensive medicine. If you are going to get serious about healthcare costs, you are going to have to deal with defensive medicine." Eventually, Woodward says, the group may seek legislation to overhaul state as well as national policies.

The aura of litigation "intimidates people so they aren't open to discussions," Woodward adds. "Lawyers have told physicians for decades, ‘If something goes wrong, don't talk to anybody but me.'"

The Massachusetts Medical Society's DA&O plan says it offers patients "a full disclosure of what happened and why (and what will be done to prevent a recurrence of the event), and for events deemed avoidable, a sincere apology and appropriate and timely offer of compensation. It won't deny patients the right to bring legal action, but would make tort claims a last resort."

The University of Michigan Health System's "apology" program has been seen as a benchmark among those seeking to establish similar programs.  The health system adopted a policy of investigating adverse events in 2002, which included the apology strategy. Using the technique over the past decade, the health system has been "incredibly successful by all the metrics," Woodward says. It has reduced the length of cases, and the administrative costs of each case by more than 60%, he adds. "There has been tremendous satisfaction on the part of physicians and even attorneys," according to Woodward.

Although there have been many organizations that have initiated the apology strategy, many physicians, obviously, don't use it. "Patients never get an apology," Woodward says. "It is something they look for. When something goes wrong, there's almost a termination of open communication between physician and patient."

A Massachusetts Medical Society study showed that there is strong support for the DA&O approach because, among other things, it is the "right thing to do" ethically, according to Woodward.

The Massachusetts hospitals, physicians, patient groups, and insurers who are carrying out the pilot want to take the University of Michigan Health System work even further by applying it to the entire state.

"What we are doing now is taking that model that has been very successful at the University of Michigan Health System, at Stanford and numerous other hospital systems across the country, and we're saying, ‘why don't we implement this as a statewide model?" Woodward says. "That's what makes this different."

What's also different is that Massachusetts Medical Society officials plan to help hospitals involved in the pilot program on a day-to-day basis when confronting potential malpractice situations.  The society is working with physicians who may have experienced malpractice litigation themselves and can serve as mentors to other physicians, he adds. 

"A mentor would be someone with a greater breadth of experience or [someone who] has gone through this themselves, who can help the clinician prepare to have a dialogue with a patient," Woodward says. When physicians discuss mistakes with patients, they can "always make the situation worse, if they make people feel worse rather than better."

In addition, the program is establishing a blog and a research system with data to support physicians. Education programs are vital, Woodward says, because "very few physicians know how to do this," referring to the apology technique.

Barriers to overcoming medical liability reform are included in the Massachusetts Medical Society's Roadmap to Reform. Among the roadblocks the report cites is physician discomfort with disclosure of errors.

But it's that very thing—admitting a mistake and saying "I'm sorry"—that's a first step towards the reform so many are seeking.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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