The Apology and Disclosure Grand Rounds NWH incorporates a video simulated error and a presentation about “When Things Go Wrong”. The presentation discusses disclosure coaching & peer support, the emotional impact of errors on clinicians, and principles for transparent & compassionate disclosure and apology.

Timothy McDonald, MD, JD, discusses factors that can make already difficult conversations with patients and their loved ones after harm events even more challenging and complex and offers recommendations to mitigate these challenges.

Jo Shapiro, MD, FACS, talked about how peer support programs can both help alleviate some negative emotional impact of medical errors on the involved clinicians and in progression towards a culture of psychological safety in organizations.

Webinar Date: January 21, 2021

Wesley R. Butler discusses the role of confidentiality and privilege within the context of Communication and Resolution Programs.

Presenter: Wesley R. Butler is an attorney at Barnett Benvenuti & Butler PLLC in Lexington Kentucky who focuses on advising health care providers on regulatory matters that implicate safety, quality, and reimbursement.

Objectives: 

• Outline the elements of typical confidentiality and privilege interests in patient safety and quality analyses, and explore the public policies that support such interests
• Outline the fundamental components of common CRP processes in health care, and explore the public policies and ethical considerations that support CRPs for responding to patient harm events
• Analyze the interplay between CRPs and confidentiality and privilege interests to identify complementary and divergent points
• Conclude with practical suggestions to illustrate that health care providers can fully implement CRP processes while respecting the boundaries of confidentiality and privilege and,  ultimately, gain the benefits that both perspectives offer

Webinar Date: February, 2021

Overview: COVID-19 has fundamentally altered our care processes and standards.  Care is being delayed, visits are happening by telemedicine, there are changes in how staff are deployed and interact with patients, and everyone is exhausted and emotionally depleted. These all make potential for patient harm events higher.  COVID-19 is also adding stress to already tightening medical professional liability insurance market. While it may be tempting to abandon ship when it comes to implementing CRP during COVID-19 times, CRPs are more important now than ever.  Fundamental principles of the CRP model-supporting patients, families, and clinicians after harm with open communication, empathy, learning, and accountability – are critical elements of how we respond to COVID-related harm events.  This webinar examines two cases of COVID-associated adverse events to help lead a discussion on the challenging aspects in implementing CRPs during this time.

Presenters: Michelle Mello, JD, PhD, and Thomas H. Gallagher, MD

Commentary by: Jeffrey Catalano, JD, Marcia Rhodes, Jonathan Steward, JD, MS, RN-BC, CEN, CPHRM

Learning Objectives: 

• Examine potential communication and legal issues associated with COVID-related harm events
• Describe how CRPs can be used as a strategy to address these COVID-related adverse events
• Learn about CRP resources to help address COVID-related challenges

Webinar Date: March 18, 2021

Richard Boothman, JD, Michael Severyn, JD, and Kyle Sweet, JD, discuss important the role of attorneys in advancing the CRP field.

Presenters: Richard Boothman, JD, Michael Severyn, JD, and Kyle Sweet, JD

Learning Objectives: 

• Describe the role of attorneys who counsel and represent healthcare systems, healthcare providers, insurers, and patients and families in the CRP process
• Examine how the traditional role of an attorney following an unplanned clinical outcome might need to shift to better serve client’s interests and everyone involved in healthcare
• Learn about the goals, work stream, future opportunities, and ways to get involved with the Attorney Alliance

Webinar Date: December 17, 2020

Presenter: Julianne Morath, RN, MS, CPPS, Founding member of the Lucian Leape Institute of the National Patient Safety Foundation

Objectives:

1.  Define the term precondition and its relevance to Transparency

2. Identify at least two reasons to embrace transparency

3. Identify at least three levels of transparency

4. Demonstrate an understanding of why being transparent is so difficult

Webinar Date: October 22, 2020

Dr. Urmimala Sarkar discusses healthcare disparities and specific challenges to adverse event communication among diverse populations within the CANDOR process.

Presenter: Urmimala Sarkar MD, MPH, Professor of Medicine at UCSF in the Division of General Internal Medicine, Associate Director of the UCSF Center for Vulnerable Populations, and primary care physician at Zuckerberg San Francisco General Hospital’s Richard H. Fine People’s Clinic

Objectives: 

• Examine disparities in healthcare and which populations are more likely to experience lower quality healthcare and adverse events
• Delineate how low-income, limited literacy, racially/ethnically diverse populations may experience the response to adverse events differently
• Characterize specific challenges for adverse event communication among diverse populations
• Identify best practices from lived experience among risk management professionals for communicating across differences in the aftermath of adverse events

Challenging Conversations with Patients and Families presented by Dr. Tim McDonald

Communicating with patients and families following unexpected patient harm can be challenging even in optimal conditions; it is a learned skill. Taking into consideration factors such as socio-economic status, religion, cultural preferences, marital status, sexual orientation and gender identity is important to communicating effectively. This webinar covers methods successfully employed by healthcare institutions to recognize, plan for, and communicate effectively in complex situations and with special groups.

Learning Objectives

After completing this webinar, attendees will be able to…

1. Demonstrate recognition of situations that require advanced techniques for communicating unexpected patient outcomes;

2. Utilize communication enactments in conducting ongoing training in these complex situations within their organizations.

WEBINAR DATE: May 1, 2020

The COVID-19 pandemic is posing a host of potential medicolegal risks for healthcare providers, institutions, and liability insurers. How should one respond to the patient with behavioral challenges who refuses to comply with social distancing? How do COVID requirements affect consent and surrogate decision-making? What new legal issues are arising with rapid expanding telehealth programs or deploying providers to new care environments such as nursing homes? In what situations should healthcare providers or organizations be provided with immunity for potential adverse events associated with COVID-19 care?

PRESENTERS:

Moderator
Thomas H. Gallagher, University of Washington
Panelists
Marcia Rhodes, University of Washington
Leilani Schweitzer, Stanford Health
Michael Severyn, ProAssurance
Kyle Sweet, Sweet Law Firm

OBJECTIVES:

1. Identify current medicolegal issues associated with COVID-19
2. Consider how medicolegal issues associated with COVID-19 may evolve in the future
3. Discuss possible ways to address these issues

CRPs: Why the insurance industry hasn’t embraced them . . . and why it should presented by Richard Boothman, JD

The driving ideas behind CRPs continue to draw interest and debate, now twenty years after Steve Kraman and Ginny Hamm published their Lexington, KY VA experience with “Extreme Honesty”.  After more than 17 years, the University of Michigan continues to draw attention transparent with their “Michigan Model”, the most successful and longest continual example of a principled, and proactive approach to patients injured in unexpected clinical outcomes.  After years of balking at abandoning “deny and defend” more health systems around the country and around the world are exploring the transition, but a skeptical insurance industry continues to hold back and sometimes, frustrate the desires of their insureds to move in this direction.  Why?  Is the industry’s skepticism well-founded and prudent?  Or is it missing a valuable opportunity?

Rick Boothman, the architect of the “Michigan Model” will initiate a long-deserved discussion into this topic.  His experience suggests that there are multiple insurance advantages in the CRP approach and the insurance industry should rethink old beliefs, practices and prejudices and embrace this model.

Outline

1. Insurance 101 – a dummy’s guide to the construct
2. True CRPs – the essential elements and how the model differs from “deny and defend”
3. What holds the insurance industry back from jumping on board?
4. What is the insurance industry missing and why should it matter?

Learning Objectives

• That too many equate CRPs only with selective, early resolution of potential and asserted claims – what are the essential elements that distinguish a true CRP from established, traditional risk management practices?
• What are the unique outcomes of a CRP and why do they matter?
• Why a CRP better serves the interests of healthcare insureds?
• What unique consequences of a CRP would benefit the insurance industry especially?

Webinar Date: September 17, 2020

Dr. Gordon Schiff talks about diagnostic error and how efforts to reduce diagnostic error align with the principles of communication and resolution programs.

Presenter: Dr. Gordon Schiff (Brigham and Women’s Center for Patient Safety Research and Practice, Harvard Medical School)

Objectives: 

1. Describe the frequency/epidemiology of diagnostic errors based on published studies and surveys.
2. Define diagnosis errors, and using a Venn diagram model differentiate diagnostic process errors, misdiagnosis, and adverse outcomes.
3. List 3 approaches to minimizing and preventing diagnostic errors.
4. Explain ways that missed/under diagnosis and overdiagnosis are related rather than just opposites
5. Describe overlapping and synergistic domains between the diagnostic error/improvement movement andCommunication and Resolution Program (CRP) efforts.

Large Scale Implementation of Communication and Resolution Programs

Presented by: Heather Gocke, M.S., RNC-OB, CPHRM, C-EFM

Webinar Date: January 29, 2020

Ms. Gocke introduces a comprehensive program and a holistic approach in reducing harm in healthcare through large scale implementation of CRP. In her presentation, she highlights the importance of disclosure and engagement, and she shares real-life challenges and secrets to success.

Learning Objectives:

1. Outline the method used to engage member sites in culture transformation
2. Learn  how culture measurement, survey data debriefs, and cognitive interviewing techniques are used to inform this body of work
3. Introduce the five domains and components of BETA HEART

Mitigating the Toll of Medical Errors on Clinicians by Jo Shapiro, MD, FACS

Webinar Date: October 31, 2019

As a clinician, being involved in adverse events can have devastating emotional consequences. How we react to these events – as individuals, colleagues and organizations – has a major effect on our organizational culture of psychological safety, provider wellbeing, disclosure and reporting, and patient safety.  Dr. Shapiro’s presentation will detail these effects and address the unique role that frontline physicians can play in supporting one another after adverse events. She will describe the peer support program developed at Brigham and Women’s Hospital and adopted by dozens of healthcare organizations. She will describe the building blocks of a creating and sustaining a peer support program, including providing the participants with the rationale to bring to leadership in advocating for peer support program resources.

Learning Objectives:

1. Identify the emotional impact of adverse events on clinicians
2. Recognize the impact this has on a culture of psychological safety, provider wellbeing, disclosure and reporting, and patient safety.
3. Provide a rationale to leadership for developing a peer support program
4. Delineate the foundational aspects of a peer support program

Webinar presented by Dr. Tom Gallagher on Thursday, June 6, 2019

Large-scale adverse events, situations in which a breakdown in care has affected multiple (sometimes thousands) of patients, pose significant challenges for institutions related to responding in ways that inform potentially affected patients without unduly alarming them and managing the follow-up. This webinar will highlight lessons learned from the field around responding effectively to adverse events, as well as key unanswered questions.

Learning objectives:

1. Describe the diversity of large-scale adverse events, and how responding to these events differs from managing adverse events that affect individual patients
2. List the key elements of an effective response to a large-scale adverse events and the tools that are currently available to assist with this process
3. Critique an actual large-scale adverse event patient notification letter and press release, and articulate opportunities for improvement in these documents.

WEBINAR DATE: July 16, 2020

This webinar outlines the concerns and questions about the collision between the judicial system and its pathway to addressing medical error and CRP programs.

PRESENTERS: Cindy Jacobs, RN, JD

OBJECTIVES:

1. Describe the basics of how the tort system operates in a medical error/adverse outcome situations
2. Describe the basics and how, when, and why CRP “apology laws,” “mandatory disclosure” laws/requirements, and healthcare licensing systems intersect and/or collide with the tort system
3. Identify key points to assist healthcare professionals in navigating intersections and collisions

The Communication and Optimal Resolution (CANDOR) process is a patient-centered approach used by health care institutions and practitioners to respond in a timely, thorough, and just way when unexpected patient harm events occur. It focuses on early disclosure of adverse events and a proactive method to achieving an amicable resolution for the patient/family and health care providers.

The video demonstrates an example of the care team’s disclosure meeting conversation with the affected family.

A short video of Dr. Shapiro speaking on disclosure of medical error to patients and families. This video is part of “Choosing Wisdom: The Path Through Adversity” documentary.

The video includes three scenarios to demonstrate how different approaches to disclosure can have an effect on the course of communication with a patient’s loved one.

Disclosure Scenarios:

1. Disclosure with No Apology
2. Disclosure with Apology of Sympathy
3. Disclosure with Apology or Responsibility

The video demonstrates how medical professionals can talk about medical errors with the care team, patients and their families. It includes two disclosure scenarios and didactic lecture on disclosure.

Key points:

1. common emotional response
2. preparing for the conversation
3. the initial conversation
4. avoiding common mistakes
5. physician support

Dr. Shapiro talks about the importance of having disclosure coaching program and fundamental principles of disclosure coaching. For more videos related to Disclosure and Apology, view the video gallery.

“We Signed Up for This!” — Student and Trainee Responses to the Covid-19 Pandemic by Thomas H. Gallagher, M.D., and Anneliese M. Schleyer, M.D., M.H.A.

Despite the risk and challenges, students and trainees showed their unrelenting desire and commitment to care for the sick. Residents helped cover extra shifts, students prepared home care kits for Covid-19 patients, and even provided child care for health care workers. The unprecedented public health crisis caused students and trainees to experienced considerable loss.

A short anonymous survey was conducted to learn how COVID-19 is affecting students and trainees. Responses from University of Washington medical students, residents and fellow reveal a mixture of safety, quality of care and practical concerns among the participants. The article also includes how leaders in medical education can provide support and convert this crisis to a valuable learning experience for all the students and trainees.