Transcription:

Bill Klaproth: (Host) Moving past the tradition of deny and defend and implementing a transparent strategy during medical errors, disclosure has many benefits. So let's talk with Anna Petersen, director of nursing at UPMC Hamot and Joanne Sorensen, director of quality, patient safety, and patient experience at UPMC Chautauqua. This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership, I'm Bill Klaproth. Anna and Joanne, thank you so much for your time, it's great to talk with you. So Anna implementing a transparent approach, following a medical error, positively impacts patient and provider satisfaction, as well as a litigation risk. AHRQ published the CANDOR Toolkit to support transparency, however, implementation remains elusive. Why is that?

Anna Petersen: (Guest) Well, it's a really good question. The CANDOR exactly, as you say, which is communication and optimal resolution published by AHRQ, disseminated their model in 2016, yet it has not been universally embraced nor implemented and managed in organizations. And we have historically been deny and defend in hospitals and facilities when mistakes happen to our patients. We didn't know how to handle them, and that includes C-suite hospital leaders, nurse leaders, many believed that disclosing these errors and walking away through those errors is the purview of the physician. And I know from a nursing standpoint, there's been a historical lack of knowledge, lack of skill, what words do I use, and even fear moving past these embedded traditions of deny and defend.

Host: Let's talk about that tradition of deny and defend and moving past that. Joanne moving past deny and defend, holds promise for collaboration of the healthcare team, patients, and families. So how do you engage those three groups, the healthcare team, patients, and families in coming up with a more transparent culture and solutions?

Joanne Sorensen: (Guest) Well, I'm going to talk about a specific incident where that happened and it was very powerful in my own life and in the life of the nursing staff at UPMC facility. About two years ago, now it started with an event that happened to a patient and we have permission from this patient and her family to tell her story over and over anywhere we can. In fact, they encourage us to tell it as often as possible. And that patient's name was Catherine A. Newman, we've since named the protocol for Kat for Kate. And, it started with a UPMC intermediation program. Which was designed to resolve conflicts without costs between providers and families. It's that you use a neutral mediator to find common ground, and we're really trying to accomplish during these events how we meet the needs of our families and patients for an apology, maybe not necessarily that you agree completely with their perspective of what happened, but the apology should be a truthful and honest apology about something happening. An explanation of what happened, or even if you're not sure what happened to cause the event that occurred, that you will keep the family and patient updated. And then an assurance that you will prevent like events in the future. Now we took that very seriously, the intermediation, and agreed with the family that we needed to make some changes. We realized that our approach to the care of non-ambulatory patients, which is what Kate was, was not as comprehensive as it needed to be. She developed pressure ulcers in our organization, which really broke the hearts of our nurses. She was a long term, multiple sclerosis patient, but she never let that define her life. In fact, she volunteered at the hospital for us, many years and that was her contribution. She believed in herself and envisioned that change was possible. What became very important for us as when we had a vibrant, shared governance council that became our vector for changes. And when I say a vibrant, shared governance, I'm talking about nursing councils at Northwest. This was a nursing issue, more so than a physician-related issue. And the councils, about 30 different nurses met with Kate's family directly. They listened comprehensively to the family's needs. Together we formulated a beautiful protocol that is still ongoing at that organization and has been shared with other organizations and spread. So by involving everyone and listening to one another caring and listening really became the vector for change in our organization

Host: Yeah, that's a great story. Thank you so much for sharing that. So it seems like there's a lot of benefit to fostering this transparent culture. Anna, why should nurse leaders and hospitals and health systems really push and move towards this new transparent culture?

Anna: We can look to the publications coming out of AHRQ as well as the Hospitals themselves who participated in developing or implementing that candor model. Imagine that the grant took place in 2009, but ARC did not publish the toolkit until 2016. And part of the publications that came out demonstrated monumental changes within the organizations. For example, in the University of Illinois Medical Center at Chicago, there was a 52% increase in incident reporting, 96% increase in peer reviews, 91% increase in patient consults as well as the self-insurance fund balance move from a $30 million deficit to a 40 million surplus. So it affects not only the staff, the patients, their families, but certainly on a level that intrigued C-suite and is bottom dollar line speaks to hospitals about the importance of implementing that model within their organization.

Host: That is amazing. So the stats then really back this up and the bottom line too, as you were mentioning Anna. So Joanne, if you could wrap this up for us, then what recommendations do you have for nurse leaders on implementing a transparent strategy during medical error disclosure?

Joanne: Well, I think first and foremost, often nurses are not aware of the policies of their organization, even related to disclosure. There's just a lot of confusion and disclosure policies should create a mechanism for nurses and others to participate in the process and to raise concerns just as Anna has indicated with her statistics, it makes a huge difference. Organizational nurse leaders we know, have a key role in disclosing processes, and should have training as disclosure coaches for their staff. It's scary when we brought all of the nurses together with the family, wondering, would they be offended, how would they respond to the family members, would they try again to deny and defend? But again, that training is critically important for nurse leaders to become disclosure coaches. Thirdly, the team disclosure process development is needed to ensure that the whole team knows what is being disclosed. Often nurses have, an ethical dissonance I would say when they're unsure of what's been said and what they're allowed to say to patients. So again, having a team disclosure process that's well thought out is critically important.

Host: It certainly seems like there's a lot to gain here, not only for the healthcare team, the patients, and families but also for the hospital and our health care system. Anna and Joanne this has really been fascinating. Thank you so much for talking with us about this today. We appreciate it. Thank you both for your time.

Joanne: Thank you.

Anna: Thank you. This was a pleasure.

Host: That's Anna Peterson and Joanne Sorenson. And for more information, please visit aonl.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Today in Nursing Leadership. Thanks for listening.