The ethics of medicine require health care providers to tell patients about adverse events that cause harm, yet these conversations occur infrequently. The University of Michigan Health System (UMHS) was one of the first health care organizations to establish and implement a policy and practice of informing patients and families when preventable harm occurs.
The principles underlying the UMHS policy are patient-centered. When harm occurs through unreasonable care, the organization must make it right. When the care that staff members provides is reasonable under the circumstances, they need to be supported even when something goes wrong. A commitment to learning from medical errors helps the organization continually improve its quality.
With funding from the Blue Cross Blue Shield of Michigan Foundation, UMHS reported its experience in the Annals of Internal Medicine. The study documents a decline in the average monthly rate of lawsuits from 2.13 to 0.75 per 100,000 patient encounters and a commensurate reduction in legal costs and patient compensation costs. While the study design does not establish causality between the disclosure practices and a reduction in lawsuits or costs, similar approaches adopted in other health care organizations suggest that transparency in the aftermath of medical harm results in multiple benefits.
The University of Illinois Medical Center at Chicago (UIC) has adopted a comprehensive, patient-centered system to respond to adverse events. UIC staff meet with the patient, apologize, and provide a remedy, whether patients want to file a claim or not. They waive fees for hospital and physician services and prescription drugs. The hospital puts a hold on bills that would otherwise be mailed to the patient’s home.
In the first two years, the policy of open and honest communication resulted in more than 4,000 incident reports annually, prompted more than 200 investigations to analyze the cause of the incidents, and led to nearly 200 system improvements. Nearly 300 conversations have taken place with patients and families, and fifty more in-depth disclosures occurred where inappropriate or unreasonable care caused harm to patients. A substantial decline in lawsuits and associated legal costs occurred, according to physician Timothy McDonald, UIC’s chief safety and risk officer.
Patient safety and medical malpractice are intertwined. The Agency for Health Care Research and Quality (AHRQ) has made this important link in its work on patient safety and medical malpractice liability. Foundations can support the establishment and growth of comprehensive systems of patient-centered disclosure in hospitals. Grant funding would be well spent to support the study and publication of research on well-developed systems of disclosure and their impact on patient safety and on liability costs. Grantmakers can multitask and strive to improve patient safety and reduce medical liability costs simultaneously.
A patient-centered approach to dealing with the aftermath of adverse events is good for patients, good for health care providers, and good for reducing health care costs.