Supporting Disclosure and Apology

Since 2011, the Disclosure & Apology Consortium, representing multi-specialty clinical leaders from each of the CRICO-insured organizations, has convened quarterly to discuss instances when a disclosure and apology discussion took place. Participants advance their skills in this discipline by sharing actual scenarios. Exploring what went well, what went poorly, and the outcome of the conversation, these sessions provide education for disclosure and apology coaches, and providers. Added value is delivered through validation of the emotional impact these conversations can have on patients, families, clinicians, and other employees.

More recently, CRICO has provided funding for projects at two organizations to explore the effective implementation of disclosure policies and their impact on clinicians and patients:

Beth Israel Deaconess Medical Center (BIDMC)

BIDMC and its affiliate institutions (Milton and Needham) have launched “A Pilot Assessment of the Communication, Apology, and Resolution (CARe) Approach to Preventable Adverse Events.” Formerly referred to as the Disclosure, Apology and Offer program, this initiative is part of a broader coordinated pilot in a variety of clinical and malpractice insurance environments within Massachusetts. The pilot leverages existing patient safety and risk management programs. BIDMC is evaluating the impact of the pilot implementation in the dimensions of safety, satisfaction, and cost, using a formal assessment of clinical and financial outcomes.

Brigham and Women’s Hospital (BWH)

The ultimate goal of “Operationalizing the Disclosure & Apology Program at Brigham and Women’s Hospital” is for clinicians at BWH to disclose all significant errors in an empathetic, transparent, and timely fashion. This project supports the creation of a robust process whereby all clinicians receive timely disclosure coaching and adverse events are routinely reported. The cornerstone of the project provides easily accessible, widely available disclosure coaching and support to all clinicians at any time.

Program offerings include:

• 24/7 availability and usage of disclosure coaching
• Access to and widespread adoption of disclosure and apology educational tools as developed by CRICO
• Integration of disclosure and apology training into departmental grand rounds and M&Ms
• Cohesion and integration with patient safety efforts, especially with regard to using adverse events to make both individual and systems changes
• Development of a robust set of process measures to evaluate the impact on providers, as well as patients and families
• Seamless integration with the peer support program to promote clinician growth after involvement in an event