AHRQ Update

HealthPact Forum Update: Standing in the Gap

“We must learn to hold the tension between the reality of the moment and the possibility that something better might emerge.” 
—Parker Palmer

Parker Palmer, an author who writes about community, leadership and social change, describes what it means to stand in the “tragic gap,” between the difficult realities of life and the knowledge of what is possible. 

At the second HealthPact Forum meeting in May, leaders from the health care, legal, regulatory, and insurance industries gathered to acknowledge the gaps and discuss accountability in responding to patients when an unanticipated outcome or medical error occurs. This was the second meeting of the HealthPact Forum—a statewide consortium of stakeholders that aims to foster better communication and transparency in health care. Physicians Insurance is a founding member.

Health care is at a crossroads, its members agreed. We must move from a medical culture that blames and shames clinicians toward a fairer, more open just culture that emphasizes transparency, safety, and professional accountability. When errors occur, patients and families deserve to have their questions answered rapidly and openly, and clinicians deserve support as well.

We have more options than to simply “deny and defend”

Patients who have experienced medical errors consistently report that they would feel relief if only their clinician had responded with transparency and compassion. An apology goes a long way when a mistake has been made in care. 

“Medicine is inherently dangerous and people working in it cannot control all the risks. There was a time when doctors talked freely to the patient, but we’ve traded it for an adversarial process. How well has ‘deny and defend’ served a purpose? It works well for the industries invested in the adversarial process, but it doesn’t work well for the patients,” said Richard Boothman, JD, chief risk officer for the University of Michigan.

A decade ago, the University of Michigan Health System (UMHS), a self-insured entity, pioneered a disclosure-and-offer program through which its hospitals, clinics, and employed clinicians rapidly investigate and communicate with patients and families when an adverse outcome occurs. The process includes making system improvements to UMHS’s care delivery.

“The sky has not fallen on us,” Boothman said. During this period, UMHS cut its claim volume and payments nearly in half and accelerated the time to resolution, benefiting both patients and clinicians.

Washington’s DRP under way

Here in Washington, HealthPact has launched its own Disclosure and Resolution Program (DRP), as part of the 3-year AHRQ demonstration project entitled Communication to Prevent and Respond to Medical Injuries: WA State Collaborative (2010-2013), which is being studied by researchers at the University of Washington (UW) and Harvard University. The program involves six health care institutions and Physicians Insurance, and will evaluate, in part, whether the positive outcomes at UMHS can be achieved with multiple providers and insurers. 

When a study event occurs, the participating facility will promptly launch an investigation and initiate support for the patient and disclosure coaching for the health care team. Together, the insurers for the facility and providers will assess and review the event and develop a joint approach to resolve the patient’s concerns. The approach includes:

  • a full explanation of what happened
  • an apology, if appropriate
  • offer of compensation or other remedies, or an explanation of why no offer is being made
  • information on any safety improvements.

Dr. Thomas Gallagher, associate professor in the UW School of Medicine, is leading the DRP. In the past year, planners have secured the partners and designed the DRP’s key elements and metrics. The DRP was formally launched this summer. 

Closing the gap 

For HealthPact Forum presenter Cat Ernevad, RN, MSN, patient safety officer at Group Health Cooperative, health care needs to embrace a just culture. She explained: “Health care organizations must recognize that as long as humans are involved in patient care, errors will occur. By focusing on transparency and improving the system—as opposed to routing out the bad apple—we encourage reporting of adverse events and overcome two fears in the health professional: fear of blame and punishment and the perception that nothing will happen anyway if they report it. This requires a shared accountability between the provider and the organization.”

In this second meeting, members of the HealthPact Forum recognize they are in the gap, yet they have a vision for better communication when an event occurs. Despite their differing perspectives, this diverse group of stakeholders is keeping its eye on the patient. In doing so, HealthPact continues to model a new and transparent way forward, one step at a time.