Harm events are inevitable. When they happen, data has consistently shown that early, open and transparent communication aids in maintaining trust between the affected parties and the clinicians involved. And it even reduces the likelihood of a claim being filed.
At Constellation, we know that communicating after a harm event is a stressful undertaking. Having procedures in place for these conversations provides a solid foundation for care teams, making it easier to know what to say and how quickly to respond. Practicing disclosure conversations with peers and other care team members can help clinicians navigate these delicate interactions, preparing them for the questions they may receive.
An organization-wide commitment to immediate, accurate and compassionate communication starts with leadership. Senior leaders need to actively participate in and promote transparent communication after a harm event has occurred. Laurie Drill-Mellum, MD, MPH, Constellation’s chief medical officer emerita stresses the importance of leadership’s role in communicating after a harm event.
“In the past, involved clinicians were told not to talk to the patient or family about an adverse outcome,” Dr. Drill-Mellum says. “But people need to be heard. Providers need to feel safe and supported in their transparent communication, including if they express an apology.”
Establishing a core communication team to initiate and organize these difficult conversations is crucial to the success of early communication. Members of this team should be selected based on their experience within the organization, their communication and interpersonal skills, and recommendations from others. They should represent a diverse range of positions.
The task of the core communication team is to assist involved care team members soon after an event occurs. This team should set an organizational goal of reducing the time elapsed between a harm event and the first conversation with those affected and should track progress toward that goal. The core communication team can be trained using Constellation’s tools, webinars and best practice guides for communicating.
Another important point: Communicating after a harm event is not a single event, but rather a series of events. Effective and empathetic communications start with many components of effective communication.
1. Acknowledge what the patient/resident and family may be feeling, avoid minimizing their reactions or questions, and invite questions. It is not necessary to have answers to all their questions, nor is it likely that you will understand exactly what caused the harm event. It is appropriate to tell them when you need more time to respond. Share objective facts about what is known at the time of the conversation, with a commitment to inform them of new information as it becomes apparent.
2. Show attention to the parties in the room, and compassion for what they are experiencing. Sit down, make eye contact and silence your phone. The patient/resident and their loved ones should feel like this conversation is the most important part of your day. Be compassionate with your explanation, and in response to their emotions. Assure them that whatever they may be feeling is okay, and understandable.
3. Focus on ongoing care, whether the care plan has changed or not. Be factual about the medical outlook, and about what the plan is medically from this point forward.
4. Assure the patient/resident and family that the team is committed to providing ongoing quality care, and to investigating fully what may have caused the harm event. Provide a contact person for all questions.
5. Apologize for what they are experiencing. Telling a patient/resident or their family that you are sorry for what they are going through is appropriate and often preserves the trust and connection that patients and families have with clinicians. An apology is not an admission of guilt, but rather a compassionate response to the situation.
6. Prepare for demands that may be made at the time of disclosure. Prepare to answer questions about future medical bills without making a full commitment before an investigation has been completed. Offering nonmonetary support, like transportation, is often helpful in diffusing demands. If possible, redirect the conversation to the immediate care needs, but be careful not to appear to be avoiding the questions asked.
Constellation and its growing portfolio of medical professional liability insurance companies, including MMIC, UMIA, Arkansas Mutual and MMIC RRG developed the HEAL Prepare Toolkit to help customers measure organizational readiness for handling and communicating after a harm event. Resources include assessments, education modules and tools aimed at preparing clinicians to communicate after a harm event.
RiskTeam@ConstellationMutual.com for more information.