Patient Safety Week Guest Blog 3: Communication, Apology, and Resolution (CARe) Advances in Massachusetts
Our third guest blog explains how patients can get better care by changes in the medical liability system. The post is by Alan Woodward MD, chair of the Massachusetts Medical Society's Committee on Professional Liability and a past MMS president, who was involved in the changes to state malpractice law contained in Chapter 224.
Every day patients seek treatment in health care facilities across the country, and every day, a few of those patients will suffer harm because of that treatment. These situations are called adverse events. Patients who experience adverse events often feel unsupported, uninformed, and angry. Physicians’ primary goal is to give each patient the best care possible, every day. But when that goal isn’t achieved, it is hard to know how to respond to what has happened – whether it is because of a mistake, or just a complication that wasn’t expected –approaching the patient about it can be difficult. For a long time, the culture of health care denied patients information, empathy, and needed support after adverse events because health care providers were advised not to speak openly and had a debilitating fear of admitting fault and “getting sued” by the patient. But it is now clear that that strategy was damaging for everyone involved. In fact, many studies show that the primary reason that patients file lawsuits is not negligence, but ineffective communication between patients and providers. (see this Making Patient Safety The Centerpiece of Medical Liability Reform, a 2006 New England Journal of Medicine article by Hillary Clinton and Barack Obama)
Now there is a new approach gaining acceptance in our state. The Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI) was founded this past year to change the culture of avoidance and fear, and to promote Communication, Apology, and Resolution (CARe) as a model to approaching adverse events. The CARe approach includes the following:
First, communicate with the patient about what happened and what it means for his or her care, and offer an expression of empathy. The patient will be given an assurance that the event will be investigated and support will be offered to the patient through a patient relations specialist, or outside support entity.
Second, after a full investigation, the patient will learn how the hospital plans to prevent the adverse event from happening again. Finally, if the health care group finds that they were at fault, they will formally apologize to the patient for making the error, and if the patient sustained significant harm, will offer the patient compensation for their injuries without having to resort to litigation. Patients will be encouraged to be represented by an attorney in discussions about compensation, to be assured that the health group is making a fair offer. Through the CARe system, health care groups give patients the support and information they need, take responsibility for their mistakes and learn from them, and offer the patient support and fair compensation in a timely manner.
This initiative is so important, not only to repair the culture around adverse events, but to improve patient safety by looking hard at our mistakes and finding ways to prevent recurrences. I am thrilled that the CARe approach is currently being formally piloted in six hospitals, and used by multiple other groups and institutions in the commonwealth, and we hope more will join us in using CARe in the near future.
MACRMI has an informational website for patients, providers, and administrators with free CARe resources, testimonials, and interactive features, which can be found at www.macrmi.info. We invite you to visit the website, and share it with friends or colleagues who might be interested. Thank you to Health Care for All for supporting the CARe program’s principles and consistently advocating for patients, and for inviting me to be a guest-blogger for Patient Safety Awareness Week.
-Alan Woodward, M.D.