Honesty really is the best policy, especially when it comes to taking responsibility and avoiding lawsuits. That is what the University of Michigan Health System (UMHS) discovered after it launched an innovative program in 2002. Before then, the health system, like many others, had a “deny and defend” strategy based on numerous fears that fueled the reluctance of clinicians to speak openly with patients about things that may have gone wrong, even in the absence of negligence. Some fears included the natural aversion to confront angry people, but for the most part the anxiety was over lawsuits, and concerns that discussions might compromise courtroom defenses or result in cancelled malpractice insurance or raised rates. However, this reluctance to speak candidly with patients resulted in a Catch-22: Patients, angry over poor or unexpected results, and not getting answers from clinicians, were turning to lawyers who would initiate the lawsuits that were causing the clinicians to be afraid to speak.
The UMHS approach was summarized as “apologize and learn when we’re wrong, explain and vigorously defend when we’re right, and view court as a last resort.” The program involves open and direct communication with the patient about the incident, an impartial peer review of the incident, and a look at whether improvements can be made to prevent similar situations in the future. If it is determined that care was lacking, the clinician and health system will apologize. If the care caused injury, a resolution, sometimes a monetary settlement, will try to be worked out with the patient.
Since the program was implemented, the number of malpractice claims has dropped from 262 in 2001 to 83 in 2007, according to UMHS. As a result of declining claims, the health system was able to reduce its malpractice cash reserves from $73 million to $13 million. In many cases, patients feel that the apology and open communication is the validation that they are seeking. Another positive outcome is that the reporting of negative incidents by clinicians is now six times higher because of decreased fear of lawsuits.