The New York Times had an interesting article this Sunday called Doctors Say 'I'm Sorry Before See You in Court, about a movement in some hospitals toward openly admitting mistakes to patients, both as a way to diffuse the tension that often leads to litigation and as way create a more open learning environment. The early results also suggest that it is one of those instances where the misguided paranoia of the legal profession -- where lawyers have counseled doctors for years to not admit mistakes -- may have done more harm than good. And lawyers are starting to change their tune on this as well. The Times reports:
At the University of Michigan Health System, one of the first to experiment with full disclosure, existing claims and lawsuits dropped to 83 in August 2007 from 262 in August 2001, said Richard C. Boothman, the medical center’s chief risk officer.
“Improving patient safety and patient communication is more likely to cure the malpractice crisis than defensiveness and denial,” Mr. Boothman said.
Mr. Boothman emphasized that he could not know whether the decline was due to disclosure or safer medicine, or both. But the hospital’s legal defense costs and the money it must set aside to pay claims have each been cut by two-thirds, he said. The time taken to dispose of cases has been halved.
The number of malpractice filings against the University of Illinois has dropped by half since it started its program just over two years ago, said Dr. Timothy B. McDonald, the hospital’s chief safety and risk officer. In the 37 cases where the hospital acknowledged a preventable error and apologized, only one patient has filed suit. Only six settlements have exceeded the hospital’s medical and related expenses.
The question of when admitting mistakes is a wise idea and how to do it is also an area that leadership researchers have studied in recent years. My next post will focus on that research, but as frequent readers of this blog know, I've always been fascinated by these issues, and have argued that the best single diagnostic question for determining if an organization is learning and innovating as it moves forward is: What Happens When People Make a Mistake?
P.S. The best book I know of on medical mistakes is Charles Bosk's Forgive and Remember. It is fairly academic, but so well-written and compelling that it is hardly dull.
P.P.S. I was reading through old posts on Metacool and came across one that is the same spirit as my diagnostic question (I should say "our" question, as it was developed with Jeff Pfeffer). Check out Diego's post Where's your place for failing?
You always find the most interesting articles! I'm honestly surprised that lawyers and doctors haven't gotten around to apologizing sooner. If there's one thing the service industry has mastered it's the power of the apology. Truly, there is little in the world that has the power to diffuse a heated situation quite like a well-timed "I'm sorry."
Posted by: Erika | May 21, 2008 at 04:11 PM
Last October Ann Fisher wrote an article for Fortune magazine titled, "Want a higher paycheck, say you're sorry". In it, she references a Zogby International poll that suggests there is a strong correlation between a persons propensity to apologize and their income level. It's a poll, not a behavioral study, but I found the results interesting nevertheless.
Timely and well said, Bob. Saying "I'm sorry", is right up there with "please" and "thank you"; one of those phrases that can make the difference between a welcoming work environment and a crappy one.
Posted by: Andres V Acosta, SPHR | May 21, 2008 at 08:40 AM
Wally,
Thanks for adding this stuff, as you say, I wish it would happen more. Here is a link to a pdf of the article that Wally is quoting.
http://www.safetyleaders.org/pdf/WSJ051804.pdf
Bob Sutton
Posted by: Bob Sutton | May 20, 2008 at 03:23 PM
Great post, Bob. Back on May 18 2004, the Wall Street Journal carried an article on this titled "Doctors' New Tool To Fight Lawsuits: Saying 'I'm Sorry'." Here's an excerpt.
"Since 2001, prominent institutions from Dana-Farber Cancer Institute in Boston to Johns Hopkins Hospital in Baltimore have made it a policy to urge their doctors to own up to mistakes and apologize. Consultants are increasingly in demand for seminars on how best to deliver lawsuit-deflecting apologies. Two states, Colorado and Oregon, have passed laws specifically saying an apology can't be used against a doctor in court.
At some medical schools, including Vanderbilt University School of Medicine in Nashville, Tenn., courses in communicating errors and apologizing are now mandatory for medical students and residents. Insurers across the nation, including General Electric Co.'s giant Medical Protective unit, are beginning to urge their clients to acknowledge errors and apologize."
The Times article references a VA hospital that has been encouraging apologies since the 1980s. The Journal article in 2004 references efforts at major institutions since 2001 as well as changes in medical school curricula. Supposedly insurance companies are on board as well.
Yet, in 2008, this is still news because it's still rare. If changing something that so many people agree on is virtually in the same place today as it was twenty years ago, what does that say about the reform of our disease-care system?
Posted by: Wally Bock | May 20, 2008 at 01:50 PM