Disclosing Unanticipated Medical Outcomes
Overview
The Joint Commission for Accreditation of Hospitals and Organizations implemented a new standard effective July 2001 requiring discussion with patients or their representatives whenever outcomes differ significantly from the anticipated outcome. In addition to the JCAHO, the AMA, the National Patient Safety Foundation and the literature in health care ethics all encourage forthrightness when there has been a disappointing outcome.
Clinicians and staff need the skill and understanding to communicate effectively when patients and families are disappointed with the outcome of care. In order to address this constructively, clinicians must understand what caused the disappointing outcome, how the patient and family feel and think about it and respond in a timely and empathic manner. This process begins with shared decision making before the fact and empathy rather than defensiveness or avoidance when the disappointment occurs. When the outcome may be the result of medical error, it requires a particularly thoughtful response on the part of the clinician, staff, organization and malpractice carrier.
- Duration 1/2 Day
- Accreditation Approved for CE
- Available To Clinicians
- Course InformationDownload PDF
Program
The workshop is typically offered in formats from 2 to 3.25 hours in length. The goal of the workshop is to enhance participants’ ability to re-establish trust and rapport in the face of adverse outcomes. Research and experience suggest that the clinician’s and organization’s abilities to effectively respond to the patient and family’s concerns and emotions are the best way to reduce the likelihood that the situation will escalate to more contentious legal processes. Where financial compensation is appropriate, the odds of reaching some equitable resolution without enormous legal expenses are greatly enhanced when the clinicians and organizations can respond effectively after the adverse outcome. Finally, clinicians, patients and families are able to acknowledge, forgive, and move on, with less emotional distress when the process of working through adverse outcomes is handled sensitively, ethically and equitably.
The workshop addresses each aspect of the communication process using lecture, video examples, small group practice and discussion to identify and practice the most effective ways of responding both empathically and non-defensively. Participants will have the opportunity to better understand organizational, ethical, and risk management aspects of disclosure along with practicing the communication skills needed with patients and families.
Objectives
By the end of the program, participants will be able to:
- Understand the rationale for greater openness when there has been disappointment with care and possibly injury associated with medical or systems error.
- Appreciate others’ perceptions of situation (e.g., patients, family, colleagues, staff).
- Consider steps to take before, during and after disappointing outcome.
- Acknowledge and respond constructively to the emotional and ethical challenges in these situations.
- Practice the disclosure skills in a variety of clinical situations.