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 5 Key Facts About Disclosure

1) Disclosure is good for doctors as well as nurses, hospitals, and insurers. An enormous & growing body of data is showing that disclosure, empathy, and (when necessary) apology (when appropriate) actually reduces lawsuits, litigation expenses, and settlements/judgments. The key is anger....disclosure keeps a lid on anger, whereas traditional deny and defend risk management strategies actually increase anger felt by patients & families, and therefore increase the likelihood of costly litigation.  Disclosure not only reduces litigation exposure, but it also provides closure and healing for healthcare professionals involved in adverse medical events.

2) Five-Star Customer Service, Informed Consent, & Good Communication Lay the Ground Work for Successful Disclosure. For disclosure to work, you have to be credible and you need to have positive, strong relationships with patients and families pre-event.  Patients, residents, and families want to be treated with respect at all times, and they also want to see doctors and nurses treating each other with respect. Absent these feelings, disclosure after an adverse event might appear to a patient/family as a form of manipulation. "Why is Dr. McGod being nice to me now?" will be the skeptical question rolling around the heads of your patients/families.  In short, you need to build strong relationships pre-event with Five-Star Customer Service.  Five-Star helps you build relationships that can survive an event and be recovered using empathy and (when necessary) apology.  Also, procedure specific informed consent will aid in credible disclosure discussions, especially where there was no error. Sorry....sending your nurse in five minutes before the procedure with a bunch of forms to sign doesn't count! You have to invest the time and energy upfront.

3) Empathetic "I'm Sorry" Immediately After The Adverse Event.  Clinicians should provide an empathetic I'm sorry immediately after an adverse event coupled with a promise of an investigation and customer service assistance such as food, lodging, phone calls, transportation, etc. "I'm so sorry this happened Mrs. Jones...I feel bad for you and your family." Notice: Clinicians should NOT prematurely admit fault or assign blame. Also, do NOT get defensive. Simply say you are sorry the event happened (as you should be!) and you feel bad for the patient/family, acknowledge their feelings, promise an investigation, and take care or assist with any immediate needs of the patient/family. Show you care! And document the chart accordingly without emotion or speculation. Write down what you said, what you promised, and any questions or comments by the patient/family.

4) Call Somebody! Call your risk manager, insurance company, defense counsel, etc, immediately after the empathetic I'm sorry with the patient/family. Inform them of the situation and tell them you need assistance with an investigation that will lead to a resolution of the situation - which may include a real apology (I'm sorry I made a mistake) coupled with fair, upfront compensation (paid for by your insurer), or more empathy if no error occurred.  Some disclosure organizations actually want clinicians to call before empathizing, in order to give a brief refresher on how to say sorry in proper context, determine if the clinician is ready and able to empathize (or if someone needs to be substituted), and possibly send a person to help with the initial disclosure and also serve as a witness.

5) Train Nurses and Staff on Disclosure!
Nurses and staff must understand their role in disclosure. No, it doesn't mean that nurses will be apologizing for docs, but it does mean that nurses and other front-line staff should know that it's OK for them to empathize - say "sorry" - and stay connected with patients and families post-event.  In fact, we want the nurses and staff to take service to a new, higher level with patients/families post-adverse event. We want nurses to be part of our effort to save and restore relationships. This is so important...because for far too long nurses have literally been told to "shut up "post-event and forced to run from their patients and families, making the docs and the organization look guilty - even if no mistake happened!   Too often nurses are stuck in the middle between doctors who don’t want to talk post-event, and the patient/family who can’t quit talking about the event.  However, when we equip our nurses with empathy and customer services tools post-event, they are no longer “stuck,” but, instead they become empowered to save relationships.

To learn more about Sorry Works! - including how to develop a successful disclosure & apology program – we recommend our best-selling Sorry Works! Book.  At 100+ pages, the Sorry Works! Book is a quick read, but it is considered to be the how-to manual for developing disclosure programs.  We also recommend considering a live Sorry Works! presentation for your leadership and staff.  Call 618-559-8168 or e-mail for more information. 

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