ATLANTA—Medical errors are the third leading cause of death in the United States, and research shows allowing physicians to offer apologies to patients and their families following errors helps prevent future patients from experiencing similar harm and can reduce malpractice lawsuits by 50 percent.
Identifying the best practices for patient, medical and legal advocates to persuade hospitals and state legislators to adopt one of the most common medical apology protocols—the Communication-and-Resolution Program (CRP)—is the focus of a new paper authored by a team led by Dr. Florence R. LeCraw, an Atlanta physician and adjunct professor at Georgia State University.
“For decades hospitals, physicians and their insurance providers and attorneys have insisted on a ‘deny and defend’ approach to medical mistakes,’’ Dr. LeCraw said. “What research is making increasingly clear, however, is that when doctors can apologize and explain to patients and their families how they will prevent future patients from being injured by the same error, it not only benefits patients and their families, but future patients, too. Studies have also found that lawsuits dramatically decrease.”
CRP is based on providers and hospitals communicating honestly to patients and families about why an unexpected adverse outcome occurred, apologizing if an error occurred, providing compensation and discussing how they can prevent a recurrence of the error with other patients. Several studies show CRP leads to fewer legal claims, reduced defense litigation costs, decreased practice of defensive medicine and reduced stress for providers during the resolution process.
The LeCraw team’s paper reviews the methods nine teams used, drawing on diffusion of innovation (DOI) principles, to try to persuade states to enact CRP laws, hospitals to implement CRP and national medical societies to endorse CRP and educate their members about it. Seven of the teams studied succeeded. Two teams that did not initially achieve success with CRP efforts, in part because they had not incorporated DOI, later applied DOI principles to promote implementation of CRP.
To achieve successful implementation of CRP, proponents should:
- meet with all stakeholders who would be affected by CRP to determine their questions, concerns and goals,
- identify the opinion leader(s) in each stakeholder group who can best champion CRP to their peers and educate them about the risks, costs and benefits of the program, and
- apply the same principles of DOI that are used to advanced evidence-based healthcare policies and practices to promote CRP and other policies that improve the public good, such as through concise, easily read one-page handouts.
“Apology programs are most likely to be adopted and to succeed when physicians are willing to take ownership of these programs and persuade their colleagues that apologizing for medical errors is not only the ethically right thing to do, it’s the smart thing to do to improve our patients’ safety and reduce malpractice and defensive medicine costs,’’ Dr. LeCraw said.
More than 200 hospitals in the United States have implemented physician apology programs such as CRP. Colorado, Iowa, Oregon and Massachusetts have adopted statewide legislation facilitating implementation of CRP by healthcare systems and providers.
Story by Peter J. Howe