Admit mistakes, show your concern
Admit mistakes, show your concern
Honesty is often the best policy
ED experts agree that when patients feel they have been treated poorly, or that medical mistakes have been made, the most effective way of diffusing the situation and avoiding litigation is to listen carefully to the complaint, admit mistakes if they have been made, and then take concrete action to demonstrate your desire to prevent such mistakes in the future.
"Several medical malpractice citations suggest the frustration of the patient or family is often due not to the egregious behavior of the provider, but to the fact that they did not acknowledge [mistakes] or develop a plan of action, so could it not happen again," notes Mike Williams, MPA/HAS, president of The Abaris Group, a Walnut Creek, CA-based health care consulting firm specializing in emergency services. He recalls an incident when a patient died at a hospital, and officials there not only acknowledged the hospital's role in the death, but put the mother of the patient on their quality improvement committee. It was cited as a best practice by the Boston-based Institute for Healthcare Improvement, Williams says. "[The hospital] did not brush the event aside, but made it central to their mission," he explains.
Karen Erickson, JD, manager, claims and insurance, for Sharp Healthcare, a San Diego, CA-based health system, says, "If you do a really good job of managing complaints, the likelihood of litigation is small. Typically the patient says, 'I wasn't heard,' or 'My complaints were not appreciated,' especially in the ED where there are often so many people there, that patients feel they are not being paid attention to."
Gerald B. Hickson, MD, professor of pediatrics, associate dean of clinical affairs, and director of risk prevention at Vanderbilt University School of Medicine in Nashville, TN, agrees. "You have to listen, even if you fundamentally disagree," he says. "Listening is one of the great ways to show respect for others." Most of the people who complain are thoughtful individuals who want to use your services again, but just need to share their complaints, Hickson says.
Tom Syzek, MD, FACEP, director of risk management at Premier Health Care Services in Dayton, OH, says, "You have to teach and practice service recovery. If you see an unhappy patient, ask them, 'Is there is something more you thought I should be doing today? Is there a worry today you think I should address?'" Syzek advises that you ask such open-ended questions to keep the conversation going and to allow the perception that you care about the patient's key concerns.
Service recovery must be a team effort, adds Hickson. "You need a team, including an advocate, whose sole role is to listen and respond," he shares. The rest of the team, he says, is "anyone who's down there," such as physicians and nurses. "They have to all take the same approach: 'Thank you for sharing that. I want to get your complaint to someone appointed by the organization, because your complaint is important to us and the organization,'" Hickson says.
The bottom line is "to try and make right what they think is wrong," Hickson says. "So, for example, if they feel you did not handle their care properly, issue a personal apology."
At Sharp, apologies are handled on a case-by-case basis, according to Erickson. "We always encourage people to say, 'I'm sorry for what you've been through, or that things turned out differently than you expected them to,'" she says. "Sometimes the doctor or I will say, 'We did the wrong thing here, and you are entitled to compensation.'"
This response comes most often when a suit has been filed and the parties are in mediation. "I will bring someone from the hospital to say, 'I'm sorry this happened to you' — usually a nurse," says Erickson. (The physicians at Sharp are independent contractors and have separate counsel.) "This can diffuse the situation and often helps avoid a jury trial," she says.
While this apology occurs after a suit has been filed, and it costs the hospital compensation, "it still keeps expenses down because we do not have to pay a lawyer," Erickson explains.
Patient advocates are 'first line of defense' Karen Erickson, JD, manager, claims and insurance, for Sharp Healthcare in San Diego, CA, believes that if patient complaints are handled well, the likelihood of litigation is small. In an effort to better address complaints, each Sharp facility has patient advocates whom she considers "the first line of defense in handling patient complaints." The patient relations staff, which serve the ED as well as other departments in the hospital, "do a lot of mediating, interpreting, and facilitating," says Erickson. "They may, for example, go to an ED doctor or nurse and say, 'Jane Doe does not feel you spent enough time with her.'" Then, she says, the doctor or nurse can go to the patient and apologize. "Since the ED is such a busy place, sometimes the problem will not get uncovered until the patient is gone, at which point the patient relations representative will tell the patient they will bring the problem to the people against whom the complaint is lodged and discuss it," says Erickson. "After they talk, they might get back to the patient and say, 'I talked to Nurse Smith about the complaint and made her aware of the problem.'" Depending on the complaint or situation, they might apologize to the patient or have the offending staff member apologize, if appropriate. "Sometimes I've had to call a doctor and say, 'This issue is really with you; do you mind calling?' but that does not happen very often," Erickson notes. |
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