In the interest of transparency and promoting communication with patients after a medical error, many hospitals have implemented a new approach called a communication and problem-solving program. This study by a team from Brigham and Women's Hospital (BWH), in the journal Health Affairs, shows that through these programs, hospitals communicate openly with patients after adverse events, seeking specific information, providing explanations and, where appropriate, assuming responsibility for the error. This strategy, which contributes to improving patient safety and fulfilling the ethical obligation to disclose medical errors, does not lead to an increase in costs related to professional liability.
The team of BWH researchers, along with colleagues from Baystate Medical Center (BMC), Beth Israel Deaconess Medical Center (BIDMC), Stanford Health Care, and Ariadne Labs, here assesses the effects on "Accountability" of these communication and resolution programs in 4 hospitals in Massachusetts. Analysis reveals that these programs are associated with improved trends in new claim rates and legal costs at a portion of the affected sites. Moreover, this more transparent and more ethical approach does not increase the risk associated with professional liability.
“The right choice” : In summary, this communication and medical error resolution program enables establishments to better meet their ethical obligations with respect to the disclosure of adverse events and to promote patient safety without incurring negative consequences in terms of liability. “ The right choice is being honest about mistakes, apologizing and compensating patients injured through negligence or mistake. And there are no adverse financial consequences to this choice ,” says lead author Dr. Allen Kachalia, Director of Quality at BWH.
This communication and resolution program called CARe (for Communication, Apology, and Resolution : communication, apology and resolution) has been implemented in a number of establishments and after its implementation the team examined its impact on the number of malpractice claims, compensation and defense costs legal, as well as the time necessary to find solutions. The trends were compared between the 6 years preceding the implementation of CARe, then a few years after their implementation in each establishment. The following quarterly rates were calculated for each hospital: new claims, new claims compensated, cost of compensation, cost of defense, total cost of liability and average cost of compensation. A claim for compensation being defined as any written request for compensation from the patient submitted to the insurer,
Transparency is not more costly: The analysis finds:
- a significant drop in the rate of new claims in community hospitals and academic health centers with implementation of CARe, and this change is not observed in hospitals not implementing CARe;
- 2 academic medical centers see a significant decrease in legal costs after implementing CARe;
- no significant change is observed in the total liability costs or in the amount of the average compensation per claim, and this in none of the hospitals.
The authors hope, by publishing these results, that more institutions will play this open communication with patients in the event of errors and/or injuries.
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