Today, in a busy clinical department of any hospital, a routine procedure took an unexpected turn. A patient was admitted for a simple cardiac catheterization. The procedure, typically straightforward, resulted in a serious event. With emergency intervention, the medical team worked swiftly to stabilize the patient.
Knowing that transparency was crucial, the care team first came together to discuss how the disclosure process would unfold, who would take the lead in the conversation and the next steps in the disclosure process.
In a quiet and private room, the attending physician, joined by nursing leadership and a cardiologist, explained the situation with clarity and compassion. "We encountered an unexpected complication during the procedure," the attending began, "and I want to assure you that we are doing everything possible to manage it." The attending detailed the steps taken to address the issue, offered reassurances as to the next steps in the disclosure process and expressed the care team’s commitment to the patient’s recovery.
This moment of disclosure, though difficult, helped the patient and family understand the situation and provide awareness as to the next steps but also reinforced their trust in the healthcare team. The patient’s recovery was challenging, but the open communication, compassion and support the patient received made a significant difference.
Adverse outcomes and unexpected complications, preventable or otherwise, are a reality of medical care. These events can range from minor issues to severe complications, and they can occur despite the best efforts of healthcare professionals.
In healthcare, transparency and trust between patients and their care team are paramount. When care does not go as planned, this balance is tested. Disclosure, the act of informing patients and their families about adverse events, plays a critical role in maintaining these values. Whether it's a medication mishap, a serious safety event, or unexpected complications, a well-established organizational disclosure program is necessary for fostering a culture of openness and accountability. Effective disclosure not only helps in managing the immediate aftermath of a serious safety event but also contributes to long-term improvements in organizational quality and ongoing patient trust.
This article highlights the healthcare disclosure process, expanding on the ethical implications, the challenges and barriers faced by healthcare providers and the strategies that can enhance the process.
In examining best practices, we aim to shed light on how disclosure can transform patient-provider relationships and contribute to the overall improvement of healthcare systems. For every medical intervention there is an expected outcome. But there’s also the possibility for unintended consequences. While it’s comforting to believe modern science can perform miracles, the reality is that human bodies often react in unpredictable ways – even when the treatment is standardized, and evidence based.
“For every medical intervention there is an expected outcome. But there’s also the possibility for unintended consequences. While it’s comforting to believe modern science can perform miracles, the reality is that human bodies often react in unpredictable ways – even when the treatment is standardized, and evidence based.”
Michael Woods | Healing Words – the power of apology in medicine, 2004, Doctors in Touch
When patients experience a bad outcome, the sudden shift in behavior from their healthcare providers can be profoundly unsettling without timely disclosure. Previously friendly and forthcoming physicians and care team members may become distant or less communicative, leaving patients feeling confused and distressed. This change often stems from the providers' own emotional turmoil, fear of legal repercussions and uncertainty about how to handle the situation[1].
For patients, this withdrawal can erode trust and create a sense of abandonment at a time when they need support the most. The lack of clear communication and empathy can lead patients to seek answers elsewhere, often turning to lawyers to help them understand what went wrong and to find some form of resolution. This step is frequently driven by a need for clarity, apology and accountability, rather than a desire for litigation.
Healthcare providers can mitigate these negative experiences by maintaining open lines of communication, offering sincere apologies and expressing empathy. Engaging with patients and their families, acknowledging the event and providing detailed explanations can help rebuild trust and prevent the distress that leads patients to seek legal counsel.
Disclosure in healthcare offers significant benefits to patients and their families, fostering trust and transparency. When healthcare providers offer disclosure following a serious safety event, it acknowledges the patient's experience and validates their feelings. This compassionate approach helps to mitigate the emotional impact of adverse events and often can strengthen the physician and patient relationship.
By openly acknowledging the event, providers demonstrate honesty and integrity, which are crucial for maintaining patient trust. Engaging with patients and their families during the disclosure process ensures they are fully informed and involved in their care decisions. This engagement, coupled with expressions of compassion, reassures patients that their well-being is the top priority.
Disclosure in healthcare raises several ethical issues that must be carefully navigated. At the forefront is the principle of patient autonomy, which requires that patients be fully informed about their care, including any adverse events or errors. Transparency is essential for patients to be better able to make informed decisions about their treatment. However, healthcare providers often face the challenge of balancing honesty with compassion, ensuring that disclosure is both truthful and sensitive to the patient's emotional state. Not every adverse outcome involves error, but every unexpected outcome warrants an explanation.
Not all serious safety events come as a result of an error. Although not intended or planned for, such events are a source of disappointment for all involved. The potential for possible complications would have been discussed in a thorough informed consent discussion by the physician or provider. After a detailed review you may still not have an exact root cause identified. The types of events, even in the event that the harm was not significant or permanent that warrant disclosure include but are not limited to the following:
Disclosing serious safety events in healthcare can be challenging due to several factors, such as:
Instiutional culture, characterized by a blame culture and insufficient support, can significantly hinder open communication. When employees fear repercussions for mistakes, they are less likely to report errors or near-misses, which can prevent the organization from learning and improving. Additionally, a lack of support from leadership can lead to feelings of isolation and stress among staff, further discouraging them from speaking up. This environment can ultimately compromise patient safety and the overall effectiveness of the healthcare system. To foster a more open and communicative culture, institutions should focus on creating a supportive atmosphere where staff feel safe to share concerns and mistakes without fear of blame or punishment.
Healthcare providers often experience significant stress, anxiety, guilt and shame when disclosing errors. They may fear negative or aggressive reactions from patients and their families or damage their professional reputation. Concerns about potential lawsuits and damage to professional reputation can deter providers from being transparent. Communication barriers, such as the complexity of explaining the error and managing emotional reactions, add to the difficulty. Concerns about potential criminal charges may also deter providers from being fully transparent.
Additionally, inadequate training and preparedness for error disclosure, inefficient reporting systems, and resource constraints further complicate the process. Addressing these challenges requires fostering a supportive institutional culture, providing adequate training and implementing clear policies and procedures for disclosure of errors.
According to American College of Obstetricians and Gynecologists, healthcare facilities should consider:
Many organizations are mandated to disclose serious safety events to their patients. Mandatory reporting systems, usually enacted under state law, generally require reporting of sentinel events, such as specific errors, adverse events causing patient harm and unanticipated outcomes (e.g., serious patient injury or death. It is estimated that less than half of the states have some form of mandatory reporting system for adverse events, a number that is expected to grow in the next few years. It is essential to know both your state and accreditation requirements.
A timeline is developed that outlines the patient’s experience with the serious safety event from the time of admission or of their office encounter until discharge. Risk management should consult with key stakeholders prior to disclosure to ensure a thorough review of the medical record, the timeline for the event and the informed consent process that took place prior to the harm.
This consultation should include discussions on the approach to be taken in the disclosure, identification of participants and determination of the specifics regarding where, how and when the disclosure will occur. Additionally, it is important to identify the lead communicator and the roles of all the participants. Ensure that there is an outline for post-disclosure activities to ensure a comprehensive and coordinated approach.
The setting for the discussion should be private and free from any loud noises or interruptions. Select a room where the patient and family can feel comfortable and safe. Make sure that the care team has placed their phones to vibrate or silenced. This small step will ensure the focus remains on the patient and the conversation.
Preparing for the conversation also includes emotional readiness for all members of the care team. Hold a brief team meeting to discuss the event and the planned conversation. Share thoughts and concerns and offer mutual support. This can help create a unified approach and ensure everyone is on the same page. Take a moment of pause to center yourselves before entering the room. Ensure that there is team support before and after the disclosure. Remind team members of the importance of transparency and the positive impact it can have on patient trust and safety.
Clearly explain what transpired and to the best of your knowledge at that point in time why the event happened. Express regret for any harm caused. Speak from a place of sincerity and truth.
Be familiar with any state with apology laws that may impact your organization.
Effective communication is a cornerstone of patient care, especially when discussing adverse events. Key disclosure communication skills are essential for healthcare professionals to ensure transparency, build trust and support patients during challenging times. By mastering these techniques, healthcare providers can foster a more open and supportive environment, ultimately enhancing patient satisfaction and safety. Let's delve into the specific skills that can make a significant difference in patient interactions.
The Agency for Healthcare Research and Quality (AHRQ) offers a full disclosure checklist for communication and optimal resolution toolkit. They also highlight key communication skills to be mindful of at the same website.
Proper documentation helps ensure that all relevant details about the event, the conversation among the care team and discussion with the patient are accurately memorialized. Accurate documentation can protect the healthcare team from legal issues. With thorough and detailed documentation, this recordkeeping can provide an outline of steps taken from the time of the event through the disclosure and possible claims process. Such information will be essential in defending against regulatory or accreditation concerns or possible claims or lawsuits.
Important elements to incorporate in the documentation would include, but are not limited to:
In healthcare, the practice of disclosing medical errors and serious safety events is not only an ethical obligation but also a cornerstone of patient-centered care. Transparency fosters trust, empowers patients and promotes a culture of safety and continuous improvement. Despite the challenges, healthcare providers can prioritize honest and empathetic communication.
By preparing thoroughly as a team before meeting with the patient, choosing the right setting to hold the conversation and ensuring emotional readiness of all involved, providers can effectively navigate these difficult conversations. As we continue to advance in medical practices, commitment to transparency and disclosure remains vital for achieving the highest standards of patient care.
WTW hopes you found the general information provided here informative and helpful. The information contained herein is not intended to constitute legal or other professional advice and should not be relied upon in lieu of consultation with your own legal advisors. In the event you would like more information regarding your insurance coverage, please do not hesitate to reach out to us. In North America, WTW offers insurance products through licensed entities, including Willis Towers Watson Northeast, Inc. (in the United States) and Willis Canada Inc. (in Canada).
