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Bill Klaproth (Host): Welcome to the ASHRM podcast, made possible by the American Society for Healthcare Risk Management to support efforts to advance, safe, and trusted healthcare through enterprise risk management. You can visit ashrm.org/membership to learn more and to become an ASHRM member. I'm Bill Klaproth. And with me is Pamela Popp, Chief Risk Officer, Executive Vice President at Gallagher Bassett; and Geri Amori, Principal of Communicating Healthcare as we talk about ASHRM's newest publication, the Communication and Reconciliation Program and Implementation Workbook for Disclosure, Apology and Resolution. Pamela and Geri, welcome.

Pamela Popp: Thank you, Bill. We're so glad to be here. We really appreciate you taking the time to speak with us about this new publication.

Geri Amori: Yes, we absolutely do. We've been excited about the publication ever since we first talked about it, and we are thrilled that you've asked us to discuss it with you and with the audience today.

Host: Well, I'm happy you're both here. Thank you very much for your time. I appreciate it. So, Geri, let me start with you. So, why was this particular publication created? Why the need and why now?

Geri Amori: Okay. Well, it's really interesting. Pamela and I have worked together in various capacities for many, many years, and we started down this whole disclosure path back in 1999 when the first IOM report came out, right? That's where everyone says that's where it all began. And we've both been working in this area of disclosure, teaching it, teaching communication skills, which is my forte, teaching more of the surrounding aspects, which is Pamela's forte.

And what we've realized is the culture has changed, the world has changed. And when we first started talking about it, it was like, "Why now? Doesn't everybody understand this yet?" But it's not about understanding it, it's about finding a correct path to build it, hardwire it so that it's expected in our organizations and part of the fabric of the way we do things. And there's also some new regulations out that Pamela's going to talk more about that really make it even more pertinent and more palpable for a need for now.

Host: Well, Geri, thank you for that explanation. That's really good to start out the podcast, so I appreciate that. Let me stay with you, Geri. So, the title includes the word reconciliation versus the more common phrase of resolution. So, can you explain that choice?

Geri Amori: Yes, I can. What happens is that often, and we've talked about systemically throughout our world in healthcare, that when we have open, transparent communication with patients and families, we can then make the changes that we need to make within our organizations that we find, and we also can help bring those families to closure. And there's been a false sense of things getting what I'm going to call resolved. In other words, kind of a closure, an ending. It's all nice and neat and packaged up. And I don't really think that's what happens much of the time. That's really also not what we're after. What we're after is the human aspect of reconciliation, that the organization and the people within it come to some sort of a meeting place with the patients and families and recognize we've all had this horrible experience together. We need to reconcile. What feels right, what is right, what went wrong, how it's affected you, and move forward from there. Whether it involves changes to the organization, whether it involves making you whole in some way, either financially or psychologically, right? But it's really based around trust, which is reconciling the discrepancy. There is resolution that can occur. Eventually, these programs lead to a closure of whatever the disruptive cause was. Hopefully, some fixing of systemic issues. Hopefully, some healing of individuals. And we could call those resolution. But what we're after, what we really can count on and what we can really build is reconciliation.

Host: I really like that, how you explain that. In reconciliation, there's reconciling the discrepancy. So, you're both come to an understanding or an agreement, it sounds like, where resolution sounds like it's more cold and cut and dry. Reconciliation is like we're both walking away with an understanding of what happened. Is that right?

Geri Amori: That's right. And, you know, the term resolution is still the term to art, right? It's still out there. Everyone's using it. Everybody wants to put a bow on it and put it away and finish it and get it cleaned up. And as I said earlier, there probably is, at some point, some resolution. But the goal of our impetus, the goal of our actions is really about helping people come to a resolve and place within themselves. But that's actually reconciliation.

Host: I feel like they feel better with reconciliation, right than they do with resolution.

Geri Amori: I think so. I think so. It's not forgotten. We're reconciled, but we're not forgotten.

Host: Right. That's very good. Well, thank you for that. And Pamela, the workbook focuses on the implementation of the risk initiative. Why is the focus on the implementation piece? And is there something forcing an implementation by a certain deadline?

Pamela Popp: Yes, Bill, and thanks for asking that. That is important here. We anticipate that most facilities are going to have some aspect of a communication and reconciliation program in place. Some aspect of a disclosure and apology program, whatever they want to call it. But what became really kind of the driving force on the timing for this was last October, so October, CMS, put out a new piece of regulation. And it is not very catchy in title, but it becomes very important. It's called the Patient Safety Structural Measures. And there are five domain attestations. And it's tricky, because it's not necessarily a requirement, that the facilities have these things in place instead/ and this is a fine line, you can imagine. But instead, it's a requirement that the facility leadership attest to, the fact that they in fact have these things in place. So, a real splitting hairs piece there. But basically, it's asking leadership to say, yes, in fact, we either have something in place or we're actively pursuing something.

And so, knowing that we now had this spotlight, as you will, on these five different areas, and the fourth area happens to be one called accountability and transparency. And so, that's where this implementation of the program comes into play. It's not necessarily that they're having to attest that they have something in place that's perfect and complete and everything else, but they in fact have something in place that starts to address the issue. And so, that really became probably our deadline as it were, was to make sure that all of our healthcare risk managers were aware of this new requirement to attest to having a program. And then, helping risk managers who really may have never created an implementation that was so facility-wide like this before.

Whenever you are rolling out a new initiative that involves every individual in the organization, that's a huge undertaking. And so, a lot of our risk managers simply don't have a background in how to do that. And so, the purpose of the workbook is really to give them a working tool to help them go through the steps of the process to roll out a program and, hopefully, allow them to later go back and reflect on some of the pieces of each step that they had to achieve in order to get this in place.

Host: I hope everybody got that. The patient safety structural measure. Did I get that right?

Pamela Popp: Yes, you did. It's a challenging title, very catchy.

Host: Very catchy. Oh my goodness. So, Pam, you mentioned this is a workbook, a working tool, right? Where you can capture your organizational vision and define stakeholder roles and record the foundations of a program, et cetera. So, how can this workbook then help a healthcare risk manager meet their 2025 goals?

Pamela Popp: Well, one of the 2025 goals is going to be able to show that they have this program in place. And again, it doesn't have to be perfect. It has to be something that has some structure to it, and in fact is at least being kind of a starting of a rollout, if you will. So, the workbook takes them through each of the steps from the very beginning of really assessing what is going to work for their facility, what the culture is going to accept, what resources are available to implement this. And then, moving forward through things like, who are the stakeholders, who needs to be involved, what is an applicable timeline that makes sense based on the resources that we have. And then, ultimately ending with, you know, not only do we have it in place, but then how do we make sure it's working? How do we continue to monitor the outcomes?

So, we anticipate that the actual implementation is probably going to be longer than a year. And so, having something that the risk manager can document and work through and be able to step away and come back to, knowing that it's a pretty big undertaking regardless of the size of your facility to implement something like this. And so, we wanted it to be a real working tool that could take them through that process. And then if CMS ever showed up on their doorstep and asked to see documentation of the process, there actually is a way for them to show some of the tools that are in the workbook that they've completed them and kind of walked through their process.

Host: Yeah, I think it sounds really useful. As you said, you can document in it, you can work through things, you can come back later to reflect on things. So, it really seems like a great way to put this piece out there, is to put it into workbook form, as you say. So, Geri, I want to ask you a question. There's a perspective that disclosure is just a way to resolve claims earlier, if you will. Can you give me your thoughts on that and whether that perspective is correct?

Geri Amori: Bill, thank you for that question, because that is one of my big bugaboos and it is really a perspective that influences the way that you go about building and implementing your disclosure program. I like to use the analogy that disclosure is sort of like a medication you take for the pain after surgery. And let me go into a little more detail and explain this to you.

You know, there was a movement a few years back where a bunch of attorneys-- primarily plaintiff's attorneys-- were saying, "We have to protect patients from disclosure." All those disclosure people, they're just trying to manipulate patients and make them not sue them. And apropos of that comes this analogy about surgery. So, follow me along here. It's a little tricky.

So, let's say you just had a big orthopedic surgery and you're in a lot of pain. I mean, bone surgery really hurts, right? So, you get a narcotic to control your pain. And let's say when you get the narcotic, which is controlling your pain. You also feel sort of more relaxed and more easily able to sleep. And you feel better. You're able to get up and do your PT. You're doing great. Now, what will we call that side effect? The side effect of feeling okay. We just say it's a side effect. It's not the reason you're taking the med. The reason you're taking your med is for the pain. And you happen to have the side effect of feeling better.

Well, let's say you do start feeling better. Now, you're healing, right? And you're going and you're doing great. But you really liked the way you felt when you were on that pill, so you keep taking it to get that side effect. Suddenly, we see there's a transition from using the medication for the purpose for which it was intended, which is stopping pain, so you can do other things to the side effect.

Now, in my mind and my experience, the reduction of claims is the side effect of the relationship that gets built with patients and families. When we are transparent, when we are honest, when we build trustworthiness, the side effect often is that they don't pursue litigation. But if you're doing the disclosure in order to make people not sue you, then you're doing it for the side effect, not for the actual intention. And I've actually had physicians and other people say to me, you know, I disclosed them. They sued me anyway. And I'm like, "Yeah, your point is?" They have the right to sue you. Maybe they have other reasons for suing you, but that's not the purpose of doing the disclosure. It is a potential result of being trustworthy and honest. And that's the way I like to teach it and think about it.

Pamela Popp: And, Geri, if I could just jump in there to tie into that, I think the danger-- because I'm a bit more involved on the resolution side of things-- when it comes to disclosure and apology, the actual logistical part of that, is then I think it's easy for people to jump to easy measurement, right? And so, whenever you have something, perhaps like a culture change, it's difficult to measure it. And I think the piece that folks easily jump to with the Disclosure and Apology program is looking at forcing to look at the financial side. So, saying that the only way we can measure this program is because we are looking for a reduction in claims, or we're looking for reduction in the amount of time that a matter is open, or we're looking for ways to save costs on lawyers. And so, I completely agree. And I love the idea of this being kind of a side effect. I often draw a pie chart when I'm teaching and say this little sliver of this pie on our pie chart is the actual claims and litigation piece.

You know, the disclosure and apology piece is so much bigger than that. It has to cover things like the second victim. It has to cover all of the pieces you talked about so beautifully about reconciliation. But it's so easy to focus on that little sliver because there's money tied to it. And so, I think it's an important piece to recognize that it's easy to default to that as being the only measurement of successful program when in fact it's only one piece of many when it comes back to looking at what's going to make a successful program.

Geri Amori: I agree with you completely, 2000%. It's absolutely true. We measure it because we can. I think what's important is for those of us who are engaged in building and maintaining and supporting these programs to have our heads on straight about why we are doing it so that we can help others recognize what Pamela just said. Yes, this is how we measure it. But that doesn't mean it's why we do it. And I think that's really, really important from an ethical perspective and a human perspective, and a public relations perspective, which is also part of what we need to look at, right? That the community wants to trust us. They need to trust us, and we need to be trustworthy.

Host: Does the workbook go into detail on this?

Pamela Popp: It doesn't. And there's a reason for that. This is the first of several educational resources that ASHRM is rolling out. And so, we wanted this one because of that CMS requirement in the timeframe. We wanted something that was kind of quick and very logistically focused for risk managers to be able to actually start the process of putting a program in place. But we know there's so much more to the story. So in 2026, we're actually going to have a full playbook that will be dedicated to disclosure, apology, communication, this discussion about reconciliation and what that really looks like. So much more content and background and theory and practice in that.

Host: So, this workbook is kind of like a part one, a phase one, if you will, that we'll work in conjunction with the ones you were just talking about coming in 2026, talking about disclosure, apology, and communication, and then others to follow.

Pamela Popp: Exactly. So, this is the snippet to get you started with their programs, because we wanted something that allowed them to actually start putting a program in place, knowing again that it's going to take a while to get this program up and going. And so, figuring that at each facility, they could start on their own timeline to actually get the initiative going, but then have time to also get some of that background and the deeper information to them within the next year.

Host: So, you're kind of building the foundation with this one.

Geri Amori: Absolutely. And if I may, the other part of that is we know that many of our larger organizations already have incredible, very detailed, very process-oriented and measured programs. And many of our smaller hospitals have not been able to really get that piece off the ground. Yes, they might do disclosure or have transparent communications, but they don't actually have something that is structured in a way that creates the whole process, the whole weight of following through. So, this is as much for them, that we've made it in a way that it's accessible to anyone. Wouldn't you say, Pamela?

Pamela Popp: I would, yes.

Host: Yeah, really useful as a foundation, kind of a building block. And then, you're getting a sneak peek as well. Breaking news here. Sneak peek more to come.

Pamela Popp: More to come.

Host: I love it. It's good stuff. Well, this has been a great discussion. I want to thank you both. Just a couple more questions, Pamela. If a risk manager needs more information on this topic, where do the resources exist?

Pamela Popp: Well, there are some great resources that already exist on the ASHRM website. And there is a series of white papers that talk about disclosure and apology. Those are free for downloading. If you do a search on the website, you'll also find some journal articles that speak to disclosure-apology-resolution programs. So, there's plenty of pieces that are available currently for the risk manager. There's also, of course, a couple of great private programs. One is AHRQ, that's the Agency for Healthcare Quality. And that has a program called Candor, C-A-N-D-O-R, that is free and available on the website for downloading. That is a federal program. So, it isn't currently being updated, but it is available for resources. And then, there's other private programs, including the PACT Collaborative, P-A-C-T, that's come out of the University of Washington that takes more of an academic, kind of logistical focus on the disclosure and apology piece. So, there's plenty of pieces out there.

Our goal is to help the risk manager by pulling a lot of that information together for them. But certainly, even today, they can go ahead and find a tremendous amount of resources on the ASHRM website.

Host: Yep. A great resource library for you. So, thanks for going through all of that, Pamela. I appreciate it. Well, before we wrap up, I'd love to get final thoughts from each of you on the new publication, the Communication and Reconciliation Program and Implementation Workbook for Disclosure, Apology and Resolution. Pamela, let me start with you. Any additional thoughts you want to add?

Pamela Popp: The purpose of a workbook is to be very logistical focus. And I know a lot of our members really like having that background information and all of the theory and everything that goes into kind of setting up logistics. So, we're just asking a little bit of patience for that with the focus on the workbook being the logistics of how do I start my program. And then, knowing that we're going to be bringing all of that additional information in. So, it's a great place to start. And I hope folks do in fact use it as a starter tool, and then stay with us as we get into the more detailed pieces of the education and training.

Host: Absolutely. And Geri, how about you wrap it up for us. Any final thoughts you want to add?

Geri Amori: Thank you, Bill. You know, I just want to add to what Pamela said in the sense that, remember, this particular publication is designed for organizations of any size. This is not one of those "We don't have lots of resources, so I can't bother." This is really something designed so that you can look at what you have, where you are, where you want to be, and to help you build something that works for you, an infrastructure that works for you. And also, just to remind people that we do this for our patients. We do this because we care. And yes, there are regulations and rules, you know, that we have to follow, but I wish everyone a success on their journey.

Host: Well, this book will help them on that journey, for sure, Geri. So, thank you for saying that. And I think it's really important what you said there about this workbook is really useful for organizations of any size. So, I think that's really important. Geri and Pamela, this has really been fantastic. I would love for you to come on back when we have phase two out there. We'd love to have you back on. You guys are great. That would be so fun. And thank you so much for your time today. I really appreciate it.

Pamela Popp: Thank you, Bill.

Geri Amori: Thank you, bill.

Host: You bet. And once again, that is Pamela Popp and Geri Amori. And to learn more about the workbook and to purchase a copy, just go to ashrm.org/ashrm-publications-bookstore. Once again, ashrm.org/ashrm-publications-bookstore. You'll see all the publications there. It's really cool. Check it out. I know you're going to like it.

And the ASHRM podcast was made possible by the American Society for Healthcare Risk Management to support efforts to advance, safe, and trusted healthcare through enterprise risk management. And just visit ashrm.org/membership to learn more and to become a member. We would like you to do that. 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. Thanks for listening,