Download MQAC: Error Disclosure – Jimi Bush

MEDICAL QUALITY ASSURANCE COMMISSION:
Error Disclosure
Washington Association Medical Staff Services
April 27, 2017
Jimi Bush: Performance and Outreach Manager
Objectives
Discuss common health care communication tools;
• Discuss how communication can transcend throughout the
health care community as a whole;
• Discuss error disclosure in the health care community;
• Review the communication and communication and
resolution program guidelines from the commission;
• Practice disclosing an error;
•
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]
Disclosing harmful events
We disclose errors and harmful events because it protects
patient safety
• Improves the culture of health care
•
•
•
Open
Transparent
• Supportive
• Teamwork
• Committed to learning • Respect
Patients want jargon-free statement that an error occurred and;
• A basic description of what the error was and why it happened;
•
•
Patients dislike explanations that seem evasive.
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]
Errors as a Learning Tool
Medical Errors Resulting in Change
Only 18% of the physicians had
received education or training on
disclosing errors to patients 1.
• Overall, 86% were somewhat or
very interested in receiving such
education or training 1.
•
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
93%
85%
85%
77%
76%
Sought more
advice from
seniors;
Started asking for Became more
supervision more
careful;
often;
Reported paying Using evidence
more attentions based medicine;
to the details of
the case;
% of residents
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]
Physicians suicide and depression rates compared to
a non-clinical professional (2013)
Emotional Impact
A recent study of 184 medical
residents found that making a
medical error was associated with a
significant decrease in quality of life
and increased rates of depression
and burnout 1 .
• It is difficult to recognize one’s
mistake, but it is necessary to face
the situation.
•
Washington State Medical Quality Assurance Commission
Depression Suicide
Men
12.8%
3.8
higher
times
higher
Women 19.5%
3-4
higher
times
higher
@WaMedBoard
[email protected]
Patient Satisfaction
•
The core elements comprising patient satisfaction include 1 :
•
•
•
•
•
•
•
Expectations: Providing an opportunity for the patient to tell their story.
Communication: when members of the healthcare team took the problem seriously, explained
information clearly, and tried to understand the patient’s experience, and provided viable options.
Control: when patients are encouraged to express their ideas, concerns and expectations.
Time spent: satisfaction rates improved as the length of the healthcare visit increases.
Referrals: when their healthcare team initiates referrals relieving the patient of this responsibility.
Continuity of care: Patient satisfaction increases when they receive continuing care from the same
healthcare provider(s).
Dignity: patients who are treated with respect and who are invited to partner in their healthcare
decisions report greater satisfaction.
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]
Why is Team Communication Important?
Communication among healthcare team members influences the
quality of working relationships, job satisfaction and profound
impacts patient safety 1.
• When communication about tasks and responsibilities are done
well, evidence has shown significant reduction in nurse
turnover 2 and improved job satisfaction 3.
• There is a direct relationship between clinicians’ level of
satisfaction and their ability to build rapport and express care
and warmth with patients 4.
•
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]
Medical Commission Communication Guideline
Overview
Help practitioners learn to communicate
effectively.
• Health care organizations should support
communication training for all
employees.
• Look at three areas of communication:
•
Office visit;
• Difficult patients;
• Communicating with seriously ill patients;
•
Washington State Medical Quality Assurance Commission
Take-Home Points
• Ineffective communication is a
primary cause of complaints filed with
the Commission.
• A practitioner who communicates
effectively creates stronger
relationships with patients and
provides safer care.
@WaMedBoard
[email protected]
Communication Guideline: The Office Visit
•
•
•
•
•
•
•
Take a deep breath
Sit down, lean forward, make eye
contact
Give your complete attention
Be empathetic
Slow down
Keep it simple
Tell the truth
Washington State Medical Quality Assurance Commission
Never answer a feeling with a
fact
• Watch the patient’s body and
face
• Be prepared for a reaction
• Make a positive statement
• Make a partnership statement
•
@WaMedBoard
[email protected]
A Collaborative Approach to Reducing Medical Error
and Enhancing Patient Safety Guideline
Physicians wonder whether to take personal responsibility for an error,
especially given that most errors are not failures of individual providers but
rather breakdowns in the system of care.
• A new regulatory model is needed, one that focuses less on punishment and
more on improving systems and preventing error.
• The Commission believes that a more effective regulatory approach is to work
directly with entities in the health care system to foster open communication.
•
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]
A Collaborative Approach to Reducing Medical
Error and Enhancing Patient Safety Guideline
Communication and Resolution Programs (CRP)
• Promote a patient-centered response to unanticipated outcomes:
•
•
CRPs are characterized by:
•
•
•
•
•
When a patient is harmed by medical care, providers should be able to tell the patient exactly what happened, what steps
will be taken to address the event, and how similar outcomes will be prevented.
Open and prompt communication;
Support for involved patients, families, and care providers;
Rapid investigation and closure of gaps that contributed to the unanticipated outcome;
Proactive resolution;
Providers must:
•
•
•
Report unanticipated outcomes as soon as they occur;
Participate in efforts to understand whether the unanticipated outcome was due to medical error or system failure;
Participate in efforts to prevent recurrences;
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]
Steps in disclosing an error
1.
2.
3.
4.
5.
Acknowledge the error;
Conduct blame-free team conversation;
Explain the error to the patient/ family in an explicit, jargon free, way;
Immediate investigation to determine the factors that led to the event;
Communicating the findings of the investigation to the patient and the patient’s
family;
a)
b)
6.
7.
8.
Explain what you/the health care system will do to correct the error
Explain what you/ health care system will do to prevent the error from occurring again
Apologize;
A change to the system to prevent the event from re-occurring;
Shared learning;
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]
NURSE
•
A helpful mnemonic summarizes
what to do in responding and
accepting patient emotions.
•
•
•
•
•
Name the emotion
Understand
Respect
Support
Explore
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]
NURSE mnemonic
Naming the emotion
• Begin by naming a patient
emotion for yourself.
• Name the emotion as to talk to
the patient.
• Read non-verbal clues that
patients display.
• Be suggestive, not declarative.
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]
NURSE mnemonic
Understand
• Builds the relationship
• Avoid premature reassurance
• Understanding may involve
Exploration
• Active listening
• Use of silence
•
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]
NURSE mnemonic
Respecting
• Non-verbal
• Verbal helps
• Respecting emotions is an
important step in showing
empathy
• Strong emotion deserves strong
acknowledgement
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]
NURSE mnemonic
Supporting
• Concern
• Articulate understanding
• Willingness to help
• Acknowledge efforts to cope
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]
NURSE mnemonic
Exploring
• It is not necessary to have had
the experience to empathize
• Put yourself in the patient’s
position
•
Washington State Medical Quality Assurance Commission
Communicate that
understanding back to the
patient
@WaMedBoard
[email protected]
RESPECT
Model
Rapport
• Connect on a
social level
• See the
patients point
of view
• Consciously
attempt to
suspend
judgement
• Recognize and
avoid making
assumptions
Empathy
• Remember
that the
patient has
come to you
for help
• Seek out and
understand
rational for
behavior or
illness
• Verbally
acknowledge
and legitimize
the patient’s
feelings
Support
• Ask about and
try to
understand
barriers to
care and
compliance
• Help the
patient
overcome
barriers
• Involve family
members if
appropriate
• Reassure the
patient you
are and will
be available
to help
Washington State Medical Quality Assurance Commission
Partnership
• Be flexible
with regard
to issues of
control
• Negotiate
roles when
necessary
• Stress that
you will be
working
together to
address
medical
problems
@WaMedBoard
Explanation
Cultural competence
• Check often for
understanding
• Use verbal
clarification
techniques
• Respect the
patient and their
cultural beliefs
• Understand that
the patient’s view
of you may be
defined by ethical
or cultural
stereotypes.
• Be aware of your
own bias and
preconceptions.
• Know your
limitations in
addressing issues
across cultures.
• Understand your
personal style and
recognize when it
may not be
working.
[email protected]
Trust
• Self
disclosure
may be an
issue for
some
patients
who are not
accustomed
to western
medical
approaches
• Take the
necessary
time and
consciously
work to
establish
trust
Table Top Exercise
Divide yourself into groups
• I will provide each group a scenario
• Practice discussing the workplace error as a team (5 Min)
•
Do so in a blame free way
• Think about how this error happened and how you plan to disclose the error
•
•
Practice disclosing the error to a patient / family member / supervisor /
licensee as an inter-professional team (5 min)
•
Think about the RESPECT model
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]
NOW STOP
•
•
One person from each group move to a different table-You are the affected party
The group will disclose the error to you
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]
Feedback
•
•
•
•
•
•
What were key observations from discussing the error as a team?
What were the key observations from disclosing the error to the affected party?
Affected parties: Did the group disclose the error honestly, clearly and
compassionately?
What are strengths and challenges of open disclosure of (medical) errors?
What are the strengths and challenges of inter-professional teams around error
disclosure?
Do you experience professional barriers that make error disclosure challenging?
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]
Questions?
[email protected]
www.doh.wa.gov/medical
Washington State Medical Quality Assurance Commission
@WaMedBoard
[email protected]