Patient Harm Disclosure Program - a Children’s Health System

When patients are harmed, it is critical that caregivers meet their treatment and information needs compassionately. And this is incredibly difficult to do under the pressures of high stakes litigation.

To strike this balance, health care systems need more than policies and training. A well-designed harm disclosure program prepares clinicians; supports clinicians and families; and aligns the various systems that would otherwise be disincentives to honest conversation.

This program included:

The hospital formed a core team of administrators, physicians, nursing leaders and risk management staff as key resource people for these difficult conversations

We designed and delivered a multiple-format training program:

• in-person skills practice offered to all physicians
• on-line, interactive, just-in-time materials for all staff and physicians
• video capture of in-person training
• intensive in-person training for core team

We co-designed a patient harm disclosure policy that encourages open discussions and gives clear guidance about reporting, arranging timely conversations, and seeking support from the core group

The policy, training and practices were coordinated with the Office of Legal Counsel and its interest-based malpractice claim management program.

Also recommended:

• Clinician support processes
• Program evaluation tools and family feedback tools
• Policy and procedure integration: disclosure and sentinel events and error reporting
• Integration with Quality Management/Performance Improvement program
• Alignment of physician and hospital interests on apportioning costs
• Integration with medical liability carrier policies about disclosure