Each module is designed to help instructors develop and meet the course objectives within a 50-minute teaching opportunity, but flexibility is encouraged to customize the content or delivery methods to fit your goals and schedules. The use of local data, systems, and cases is encouraged wherever appropriate. While each module is offered in a linear format, that is only one delivery option (there is no "right way"). We encourage you to add, delete, rearrange, and customize the accompanying materials, tools, and references to meet the needs of your particular audience. If you need assistance, either technical or instructional, please contact the CRICO/RMF Patient Safety Education Program Director.
Whatever you create from the Core Curriculum materials will be unique, and of interest to your colleagues. Please use the feedback links located throughout the site to share with us, and future instructors, what worked, what didn't, how your audience responded, and any suggestions for an optimal learning opportunity.
A culture of safety is one that discloses unanticipated outcomes to patients. This culture is based on transparency, honesty and respect. Sharing of bad news is difficult. It is more difficult if the harm may have been caused by something that we may have done. This program presents an overview of the steps that one should take in preparation for and when disclosing unanticipated events. It does not offer a “how to.” Role play is one method of working with staff to apply the principles in this course.
If you have questions about disclosure and apology within a Harvard medical institution, please contact Ann Louise Puopolo at 617-495-5100.
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Disclosure is driven by ethical, regulatory, and patient-centered forces. In other words, your colleagues, your payors and accreditors, and your patients believe it is the right thing to do. Handling disclosure properly can help avoid or minimize damage to the provider-patient relationship.
This brief synopsis may be helpful as a handout to attendees prior to or at the beginning of your program.
In a survey conducted on behalf of the National Patient Safety Foundation (NPSF), as many as 95 percent of the respondents (patients) wanted to know about even the most insignificant errors related to their health care.
Disclosure of errors and unanticipated outcomes is a key element of the patient safety movement. The NPSF adopted a principle of practice stating that “the patient and the family or representative should receive a truthful and compassionate explanation about the error and the remedies available to the patient.”1
Many of today’s patients are more informed, ask more questions, and expect to be more involved in their health care decisions than previous generations. And patients want their physician to acknowledge an error in some way, even if an error seems minor.2
Healthcare professionals no longer debate the reasons to disclose but are now more focused on how. Among the many factors one must understand about disclosure of unanticipated outcomes
A second challenge in properly handling disclosure is that many physicians have little training in dealing with mistakes or giving bad news. If the bad news is the result of what someone may have done wrong, the news is even more difficult to deliver. Professionals trained to provide leadership and support to patients in the diagnostic and treatment realm have difficulty acknowledging mistakes—especially since this is not an area in which they receive training during their educational preparation. Clinicians must be prepared to handle reactions such as patient anger and personal assaults on their competence. They must also realize that patients may not fully understand what is being disclosed nor the consequences of the injury. Ill-prepared clinicians may simply choose to avoid situations such as these and not deal with the patient.
Possibly the biggest obstacle to physicians’ willingness to disclose errors is the fear that disclosure will lead to a malpractice claim or lawsuit. The fear of being named in a lawsuit is significant. A survey of CRICO physicians completed in 2000, reported that 47 percent of the respondents were either highly or extremely concerned that they would be named in a lawsuit in the next five years. The reality of malpractice is that, of the physicians insured by CRICO since 1976, 90 percent have never been named in a claim or suit.3
Where your work crosses the medication path, and where you see problems arise, is where to get started.
