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The Value Of An Apology

Wed, 08/25/2010 - 7:31am
Amanda Hankel, editor

The value of an apology – a heart-felt “I’m sorry” – can be seen in many facets of our lives. Often, no matter how big or small the mistake, an apology is a good start to remedying the situation. Still, it seems to be human instinct to try to cover up the mistake, not talk about it or deny that it happened whenever possible.

The value of an apology – a heart-felt “I’m sorry” – can be seen in many facets of our lives. Often, no matter how big or small the mistake, an apology is a good start to remedying the situation. Still, it seems to be human instinct to try to cover up the mistake, not talk about it or deny that it happened whenever possible.

When you were a kid, did you ever break an item at your parent’s house and try to clean it up, hoping no one noticed? Chances were good that mom or dad figured it out and in the end, the fact that you tried to cover it up rather than simply fess up and apologize made the situation worse.

As a medical student, resident or new nurse in-training, did you ever make a tiny, miniscule mistake that no one noticed? Did you point it out to your superiors, even if it had no impact on the patient or procedure, or did you let it slide, learn from it silently, and move on?

No one wants to admit their mistakes, probably due to fear and/or embarrassment. Sometimes, for the sake of our pride, we can get away with hiding our mistakes. In many of instances, though, the outcome is often better when you embrace the situation up front with an apology.

In hospitals, when a clinician makes a mistake that impacts a procedure, it’s often the risk management strategy to not discuss the event among colleagues or with the family for fear of litigation. But is this the best way to approach medical errors?

According to a recent article on nytimes.com, the value of an apology is strong when it comes of medical errors. As Dr. Pauline W. Chen writes, open disclosure with patients about medical errors has been positively linked with patient satisfaction for years.

In the 1980s, Chen says, the Veterans Affairs Medical Center in Lexington, Ky., decided to institute a ”humanistic risk management policy” to medical mistakes. This meant that when a mistake was made, a process of early review of the events, full disclosure to patients of accidents or errors, fair compensation for injuries and a continuing relationship between clinicians and patients followed. This strategy appeared to decrease liability claims and costs.

Now, a study published recently in The Annals of Internal Medicine supports the idea that apologizing for medical errors decreases liability costs and does not lead to more malpractice suits.

According to an article reporting on this study, the University of Michigan instituted a policy in 2001 prompting staff to report medical errors, apologize for them and offer compensation when the health system found a medical error caused injury.

Before this policy was instituted, the health system would forward claims to a defense counsel to review and advise whether to settle or go to trial, the article states. The study found that new claims, liability costs and the time it took to resolve claims all went down after the policy was implemented.

According to the article, additional findings about the impact of the policy include:

  • The time it took to resolve a claim decreased from approximately 16 months to less than a year.
  • The monthly rate of new claims fell from about 7 per 100,000 patient encounters to about 4.5 per 100,000.
  • The number of lawsuits the health system experienced decreased from approximately 38.7 per year to about 17.
  • The annual spending at the health system on legal defense decreased 61 percent, and the average cost per lawsuit decreased from $405,921 to $228,308.

The study predicts there are multiple explanations for these results – perhaps that the policy generated a safer culture among hospital staff, or that patients were more satisfied with being offered an apology and explanation for an error rather than simply being shut out, so they decided not to sue. Either way, it seems this policy has contributed to multiple benefits for the hospital, including increased patient safety, less lawsuits and improved clinician-patient communication.

It’s important to take from these findings that the value of an apology is more powerful than we often perceive. Surgeons and surgical staff are humans, and being such, mistakes will be made within the walls of a hospital. This study suggests that patients and their families actually do understand the humanness of their doctors, and they are more willing to hear out a clinician who has made a mistake if they are treated with the respect and dignity they deserve. That, it seems, often starts with an apology.

What's your take? E-mail amanda.hankel@advantagemedia.com

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