Disclosing Unanticipated Medical Outcomes
When there are adverse events and outcomes in a patient’s care, providers’ responses have a powerful effect on all the parties’ ability to communicate about and resolve the situation satisfactorily. Accrediting bodies, professional organizations, state legislatures and compelling research on disclosure and resolution after adverse outcomes all encourage forthrightness when there has been a disappointing outcome. Effective communication that leads to a satisfactory resolution in these painful situations involves four considerations: the ethics involved, the need for psychological healing, understanding of legal requirements and the tort system and recognition of the business/economic consequences. In order to develop the perspectives and skills needed to accomplish this, IHC has created a series of programs of varying intensity and depth for practicing clinicians, risk managers, administrators and others who will be involved in helping to communicate about and ultimately resolve these situations with patients and families. IHC also offers a more in-depth and extended program entitled Managing Communication after Unanticipated Medical Outcomes (MCUMO) for experienced risk managers and administrators responsible for organizational responses to adverse events.
- Duration 1/2 Day
- Accreditation Approved for CE
- Available To Clinicians
- Course InformationDownload PDF
Disclosing Unanticipated Medical Outcomes is designed for clinicians in all practice specialties and settings. Organizational risk managers and administrators who direct the organizational response when serious harm has occurred also find the program valuable.
Participants will learn the ethical, psychological, legal and business aspects involved in pursuing a successful resolution with patients and families after unanticipated adverse events and outcomes. Participants learn about the AID model to guide clinicians in their approach to the disclosure situation, including:Acknowledging to the patient and family their timely and empathic recognition of the disappointment that has occurred, but without conjecturing about causation prior to a conclusive investigation; Investigation to develop clarity about causal contributions; and Disclosure of the results of the investigation and their impact on the patient and his/her care.
For situations where the care was reasonable yet still resulted in an adverse event or outcome, the ALEE approach provides a useful framework: how to Anticipate and Adjust to start the conversation, how to Listento learn patient and family thoughts, emotions concerns and questions, how to Empathize with painful emotions without becoming defensive and how to Explain the contributors to the adverse outcome and answer questions and give explanations that demonstrate that the care provided was reasonable.
This program also addresses situations where there were sufficient problems in the care and the investigation concluded the harm should have been preventable. Here we teach the TEAM approach: presenting the Truth(the conclusion of the investigation) in a sufficiently Transparent manner that addresses the patient’s and family’s ability to understand and is done by a Team of people brought together thoughtfully in recognition of who and what will be needed to pursue resolution. The TEAM model also teaches Empathy skills for recognizing and responding to the full range of impacts, Apologizing and demonstrating Accountability to solve the problems in care that caused the harm and finally, Managing all aspects of the situation through to the best resolution possible.
By the end of the program, participants will:
- Understand the rationale for greater openness,
- Appreciate others’ perspectives and needs,
- Review the qualities of an effective disclosure,
- Recognize how determining the causes of an adverse outcome informs the path to resolution,
- Identify skills for engaging in effective disclosure conversation with patients and families, and
- Practice the disclosure skills in a variety of clinical situations.
Workshop duration varies from 2 hours (focused on key concepts and skills) to 3.25 hours (providing greater opportunity for skill building with simulations). Attendance is limited to 25 to ensure full participation and effective interaction. The workshop addresses each aspect of the communication process using brief lectures, a focused review of the salient literature, video practice cases to trigger recognition and skill development and small group practice and discussion to identify and practice the most effective ways of responding both empathically and non-defensively. Cases are presented from various specialty situations and address situations of minor and most serious adverse outcomes and situations where the care was reasonable as well as situations where the standard of care was breached.
The Institute for Healthcare Communication (IHC) takes responsibility for the content, quality and scientific integrity of this CME/CE activity. IHC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Institute for Healthcare Communication designates the Disclosing Unanticipated Medical Outcomes workshop for a maximum of 3.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The Institute for Healthcare Communication and the University of Pittsburgh School of Nursing are collaborating to jointly provide this program. Nurses completing the program requirements and submitting an evaluation tool will receive a maximum of 3.25 continuing nursing education contact hours. The University of Pittsburgh School of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
Continuing education (CE) credit may be available to non-physician, non-nurse participants. IHC will provide a certificate of completion, which can be submitted to learners’ respective accrediting organizations. IHC is pleased to provide any necessary documentation to help learners gain CE credits for completion of this activity.