New Approaches to Transparency - ehcca.com · Reporting Investigation Communication Apology with remediation – including waiver of hospital and professional fees Process and performance

© 2008 The Board of Trustees of the University of Illinois

New Approaches to Transparency

Timothy B McDonald, MD JD Professor, Anesthesiology and Pediatrics University of Illinois College of Medicine

Chief Safety and Risk Officer for Health Affairs University of Illinois Hospital and Health Sciences System



Quality Colloquium “Communication” Boot Camp Faculty

Rick Boothman JD, University of MichiganBill Sage MD JD, University of TexasTom Gallagher MD, University of WashingtonMichelle Mello JD PhD, Harvard SPHAlan Lembitz MD, COPICJeff Driver JD, StanfordAlan Woodward MD, MMSKen Sands MD, Beth IsraelJanet Cohn JD, NYSDPHChristine McCoy JD, Ascension HealthTim McDonald MD JD, University of Illinois


Some more background

Institute of Medicine:1999 report that shook the medical world







Making Matters Worse


February 2012, Volume 31, Issue 2

Part of the issue


Impact on the medical malpractice community


Extreme Honesty and TransparencyBarriers Benefits


Extreme Honesty and TransparencyBarriers

FearsLitigationNational Practitioner Data BankShame, blameReputationLack of skillsLack of process

BenefitsLearningImprovingLess litigationLower costsIntegrityMoraleHealing


Bottom linePatient Safety benefits far outweigh risks.


A Comprehensive Response to Patient Incidents: The Seven Pillars. McDonald et al Quality and Safety in Health Care, Jan 2010

ReportingInvestigationCommunicationApology with remediation – including waiver of hospital and professional feesProcess and performance improvementData tracking and analysisEducation – of the entire process


Goals of the Seven PillarsReduce harm thru transparency and learningReduce lawsuits through early, effective communication with all partiesResolve inappropriate care cases early, efficientlyDefend appropriate care vigorouslySupport patient and family engagementSupport care professionals following harm events


The Original Seven Pillars: A Comprehensive Approach to the Prevention and

Response to Patient Events

Unexpected Event reported toSafety/Risk Management

Patient Harm?

Consider “Second Patient”Error Investigation

Hold bills

InappropriateCare?

Full Disclosure with Rapid Apology and Remedy

Process Improvement

Data Base

Yes

Yes

No


What’s wrong with this picture?????


Patient Harm?


Hold bills

InappropriateCare?


Process Improvement

Data Base

Yes

Yes

No


After Patient and Family Engagement in Telluride 2006


The Seven Pillars: A Comprehensive Approach to the Prevention and



Patient Harm?


Hold bills

InappropriateCare?


Process Improvement

Data Base

PatientCommunicationConsult Service

24/7Immediately

Available

Yes

Yes

No

No

“Near misses”

Activation of Crisis Management Team –

emotional first aid


You cannot fix what you do not know about


Challenges to reportingOvercoming fears

Shame and blameAngering supervisors, co-workersProgram punishment

Establishing relevanceReporter apathy – No feedback

Health system – no QI feedback for reporterIndividual – no learning for reporting


Addressing the challengesProvide method for safe, confidential reportingEnsure non-retribution to reportersProvide immediate educational feedback to learner (experiential – foundational and customized)Provide regular aggregated, de-identified educational feedback to hospitals, programs, reportersLink to quality and safety process improvementsAlso focus on important learner specific issues such as fatigue, supervision, hand-offs, professionalism.


ReportingReporting established as an expectation and part of Core Competency assessment



Resident physician occurrence reporting data Journal of Graduate Medical Education, June 2010


Event data





Patient Harm?


Hold bills

InappropriateCare?


Process Improvement

Data Base


24/7Immediately

Available

Yes

Yes

No

No

“Near misses”


emotional first aid


Peer to peer support: for physicians by physicians





Patient Harm?


Hold bills

InappropriateCare?


Process Improvement

Data Base


24/7Immediately

Available

Yes

Yes

No

No

“Near misses”


emotional first aid


Pillar 2 - investigationWhat happened and why?


Human Factors Input





Patient Harm?


Hold bills

InappropriateCare?


Process Improvement

Data Base


24/7Immediately

Available

Yes

Yes

No

No

“Near misses”


emotional first aid


CommunicationTimelyEffectiveCoordinatedOngoingEngagement of highly competent communicators – case exampleJust in time supportInterdisciplinary


Creating a communication consult service

Communications assessment toolMeasures emotional intelligenceAssesses cognitive complexityIdentifies highly skilled communicators in complex social situationsBalances out the “special colleague” issue


Individual Differences in Communication Competence

Some people are more skillful communicators than others.Some communication tasks/situations are much more difficult than others

Easy: describe your apartmentHard: disclose a medical error to a grieving family

Differences in skill most visible in hard situations

33


One hospital’s data





Patient Harm?


Hold bills

InappropriateCare?


Process Improvement

Data Base


24/7Immediately

Available

Yes

Yes

No

No

“Near misses”


emotional first aid


Elements of resolution/remediation• Patient Safety Compensation Card – given to

patients if harm caused by inappropriate care, serves as their ongoing “insurance card”


Putting it all together


October 7, 2011


Another communicating openly and resolving early


October 7, 2011


Pillar 6 - data




Other stakeholder buy-in prior to grantMedical SocietiesProfessional liability companies – hospital and physicianHospital AssociationLegal groupsConsumers Advancing Patient SafetyProject Patient CareIndividual hospital boards, medical staffs


AHRQ Grant10 private hospitals, self insuredOpen medical staffs, private professional liability coverage7 from faith-based system2 from a “for profit”1 underserved inner cityMost with resident physicians


Next stepsAHRQ Task Order


Next steps to new approachesAHRQ Task OrderCreate comprehensive set of validated and tested tools to facilitate the implementation of the Seven Pillars across all hospitals


Next steps to new approachesAHRQ Task OrderCreate comprehensive set of validated and tested tools to facilitate the implementation of the Seven Pillars across all hospitalsAgency for Healthcare Research and Quality announcement soon


Questions?

Documents

New Approaches to Transparency - ehcca.com · Reporting Investigation Communication Apology with remediation – including waiver of hospital and professional fees Process and performance