The New America Foundation’s Joann Kenen has posted an insightful piece on how some innovative medical centers deal with medical mistakes: Rather than stonewalling patients and relatives, they “Disclose. Apologize and Fix.”
But as Kenen points out, this is not just about apologizing. Or as she puts it, it’s not enough to say: “Something went wrong. We’re sorry. Here’s a check. Ciao.”
Moreover, she notes that “there are many obstacles to expanding this model. The best known examples [of places where full disclosure has proved successful are], like the University of Michigan or the Lexington VA center, staff models. The doctors are part of the hospital staff and everybody is covered by the same malpractice insurer. That’s not true in most hospitals, and there can be numerous doctors, numerous insurers, all with their own take on what happened and whether to disclose — or deny.”
Kenen reports that the Agency for Healthcare Research and Quality (AHRQ) is reviewing grant proposals from health systems around the country that are interested in exploring ways to overcome the obstacles.
If more hospitals could pursue this approach, it would help rein in health care spending. The cost of malpractice insurance and paying hospital counsel to defend suits is hidden in our hospital bills. Settlements are cheaper than suits, because a hospital avoids the costs of a drawn-out legal battle. Rather than paying lawyers to go through the endless process of legal “discovery,” the hospital, doctors and nurses explain what actually happened. Less is spent on legal fees, and the patient or family are likely to wind up with a larger sum to compensate for medical injury.
By contrast, so-called tort reform caps the award –and this may discourage lawyers from taking malpractice cases. But when patients do sue, malpractice insurers still wind up paying a fortune in court costs and lawyers’ fees. This, in turn, hikes malpractice insurance premiums.
More importantly, tort reform does nothing to improve hospital safety. By contrast, hospitals that “disclose” also “fix.” No one pretends that that the hospital makes no mistakes. They trace what went wrong, (often it’s a system error) and repair. Moreover, as Kenen explains, hospitals that discuss medical injuries with patients also discuss mistakes internally:
“Hospitals that are succeeding with this model have had to change their culture in myriad ways,” Kenen writes. “They need to make sure that everyone from the executive suite to the greenest intern or lowest-paid aide know it is safe — not just safe but welcome and essential — to report errors, near errors, and potential errors. They need to create better mechanisms for figuring out if a bad outcome was avoidable, and to put in place any new protocols or safety systems to prevent it from happening again.”
Medical mistakes lead to needless suffering, and longer hospital stays. This is the best way to lift the quality of care while simultaneously saving health care dollars.
Finally, Kenen chats with Dartmouth’s Elliot Fisher about fear of malpractice, tort reform– and whether tort reform leads to less over-treatment. See her entire post on The New Health Dialogue.