Hospitals in pursuit of excellence

Disclosure and Apology, What's Missing?

A report based on an invitational forum held on March 13, 2009, sponsored by Medically Induced Trauma Support Services,  Massachusetts Medical Society, CRICO/RMF and ProMutual Group.

This report and publications listed in the references and further readings provide guidance for establishing these programs. The following list of recommendations reflects what we have learned from the experience and expertise of early adopters—pioneering health care professionals who have articulated the need for support and a small number of institutions that have implemented programs.

1. Programs may take many forms, but some kind of support should be made available for all clinicians and staff members.
2. Programs should be established as soon as possible and publicized widely, so that individuals will know how to access help in the immediate aftermath of an event.
3. Clinician and staff support should be part of each institution’s operational response to adverse events.
4. Support programs must reflect the circumstances and culture of each institution. An institution may want to develop separate programs for different elements of the workforce. The kinds of programs that have proved to be helpful include: peer support, employee assistance programs and psychological and psychiatric counseling.
5. Don’t assume that individuals whose involvement in the event seems peripheral will not experience stress and will not need support. Similarly, don’t prejudge what constitutes an “adverse” event. Managing these programs successfully means being observant and flexible about the needs of different individuals.
6. Pay especially close attention to clinicians who are involved in disclosure and apology discussions following adverse events. They may have urgent needs for support and may engage with patients and families more effectively if they, too, feel supported.
7. Support programs will not be successful without visible commitment from the institution’s executive and medical leadership.
8. Fear of legal action should not prevent someone from getting the emotional support they need following an adverse event. While clinicians should avoid discussing the details of the medical case and event outside of privileged communications with legal counsel, they may talk about their feelings without fear that those discussions will be used against them in court.
9. Clinician support programs may be characterized as protecting an institution’s investment in its workforce and supporting favorable return on investment. At this early stage, there is not much data available to support the business case for support programs, but a case can be made based on anecdotal evidence and common sense.

MITSS will continue to contribute to awareness and development of programs that support clinicians and staff members following adverse events. The individuals, institutions, and organizations that participated at the Forum in March 2009 helped to advance this issue with their honest and generous contributions.