VOICES FROM THE INDUSTRY: A positive shift in health care: It's OK to say you're sorry

February 5, 2007

Last September, when tragic errors led to the deaths of three infants at Indianapolis' Methodist Hospital, the hospital did something that, just a few years ago, might have seemed unthinkable: It acknowledged the tragedy and admitted that mistakes were made.

"We are all saddened by this news and our hearts are with this family and all the families who have been affected," a hospital spokesman told The Indianapolis Star. Added Methodist President and CEO Sam Odle, "Ultimately, the blame for our errors falls upon the institution."

While this response might seem perfectly appropriate and humane, it stands out because, for years, health care organizations from massive medical centers to individual physicians did all they could to avoid admitting error or accepting blame. Stung too often by large malpractice judgments, the medical community typically retreated into denial or, at best, silence.

As a 2001 medical journal article put it, "Unfortunately, the current adversarial legal climate is perceived as a disincen tive for many physicians to be honest about error."

Over the last few years, however, there has been a decided shift in the way health care organizations deal with bad news. Rather than hiding behind legalistic language, health care providers have stepped forward and acknowledged that mistakes were made.

The reasons why

Why this shift? A few factors are at work.

First of all, there's the law. Across the nation, states are enacting legislation requiring hospitals to report errors. Indiana's medical error reporting law went into effect Jan. 1 with what is considered to be among the country's strictest guidelines.

Everything from medication problems to surgeries conducted on the wrong body parts will be reported for individual hospitals, allowing the public to know exactly what facilities have made errors.

Second, while health care organizations have long feared that apologies could be used as admissions of liability, evidence suggests that apologizing deters lawsuits. National media have reported a number of instances in which victims of medical errors declined to sue after receiving apologies.

Newsweek recently told the story of Linda Kenney, who nearly died as a result of an anesthesiologist's error but who, after receiving an apology, chose not to sue. She told a Boston TV station that hearing an apology, "... was like freedom to move on."

But there is more than anecdotal evidence. Hospital systems are reporting a sharp decline in legal costs as a result of apology programs. One of the most-cited examples is the University of Michigan hospital system, which saw its annual legal costs drop by two-thirds after it embraced an "I'm sorry" policy.

And the worry that apologies provide ammunition to plaintiffs? It's quickly fading, because 29 states have passed laws saying that an expression of apology cannot be used as a legal proof of liability.

Finally, the health care industry seems simply to have recognized that legalistic responses to errors have hurt its reputation, and that the same communications practices that work well in the best of times also should be employed in the worst of times.

Taking steps

So, how should health care organizations communicate? Openly, candidly and systematically. Following are some basic steps that should be taken when a crisis occurs.

Get the facts. When an error is discovered, immediately gather all the infor mation necessary to communicate about the problem and about your organization's actions.

Assemble your team. Every organization should have a crisis-response team. Quickly pull your team together and make assignments.

Define the problem. Make sure you understand the problem, who was involved, the chain of events, etc.

Prepare a statement. Develop a written response to the situation, as well as talking points for everybody in your organization.

Communicate internally. Your own people should never hear bad news from the media or other outside sources. Brief them, providing them with copies of any news releases you'll be issuing and talking points to help them talk with outsiders.

Work with the media. If this is a story that's going to be news, cooperate fully with the media. This will give you a better chance to help shape the story and, as a result, public opinion.

Designate a spokesperson. Appoint someone to speak for your organization and direct all inquiries to that person. If other people are needed for expert insights, prepare them and limit their responses to matters of their expertise.

Go public. As soon as you have enough information to talk to the public, do so. Again, this will allow you to help shape the story.

Acknowledge the tragedy. The first words out of your organization must show concern and compassion for the victims and their families.

Unload the bad news. Get the bad news out right away.

Accept the blame, and apologize. If the blame lies with your organization, acknowledge that and express sympathy for those people affected.

Use compassionate language. Communicate with common words, not legal or medical jargon.

Balance legal concerns with the need for transparency. Don't lock the lawyers out of the room, but don't let legal concerns dictate your actions.

Describe your reaction. Let the public know what you're doing in response to the problem, and how you'll try to avoid it in the future.

Provide updates. Keep the public updated about developments in the story.

Even the best health care providers will occasionally run into problems. By communicating openly in such times, you can limit damage to your organization's reputation and, at the same time, express the compassion that befits your mission of helping and healing.

Laura Miller advises clients at Hetrick Communications, an Indianapolis-based marketing communications firm with a focus on health care and the life sciences. Views expressed here are the writer's.
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