Three years before the Institute of Medicine issued To Err is Human, its 1999 report on medical errors, the Annenberg Center for Health Sciences, the Joint Commission on Accreditation of Healthcare Organizations, and the American Association for the Advancement of Science founded the Annenberg Conference on Patient Safety. Held in 1996, the first conference made the cover of USA Today, spurred the formation of the National Patient Safety Foundation, and generated a conference series. The next conference, Let's Get Practical, hosted by NPSF, the Annenberg Center, and others, is slated for April 22 in Indianapolis.
After viewing video clips of the third conference, Let's Talk: Communicating Risk and Safety in Health Care, held in May, we asked Stephen Biddle, administrative director, continuing education with the Annenberg Center in Rancho Mirage, Calif., what his organization has learned about the role of communications skills in error prevention.
Q: Why did the third conference focus on communication issues?
A: We have learned that our health care system is based on human factors. By default, we are fallible. Period. If you couple the complex nature of health care systems along with the human factors, then staff-to-staff, and staff-to-patient communication is a natural next step in avoiding errors.
Gerald B. Hickson, MD; and James W. Pichert, PhD, Vanderbilt University, Nashville, Tenn., put on a great presentation titled “Communication: It's More Than Just Talking.” They discussed why parents of children born with significant neurological injuries sued for mismanagement of labor delivery.
This 1992 study found that 24 percent of those who sued believed there was a cover-up and 20 percent stated that no one would tell them what happened. So nearly half of those suing did it out of the need for more information — isn't that interesting? Although the study is dated, we are hearing more and more parents (and patients) saying, “I don't care about the money. I don't care about revenge. I'm not thinking about the future of my child or a cover-up. I just don't want to see this happen to anybody else.”
Q: Another speaker said physicians ask: “Why should we acknowledge and apologize for errors that patients might not know about?” How do you convince physicians of the importance of disclosure and apology?
A: For starters, it is good ethical and business practice. What we learned at the conference is that the Lexington, Ky., Veterans Affairs Medical Center has been practicing full disclosure for some time now, and they've been successful. Success factors include communication, prompt — very prompt — investigating, and getting everyone involved, meaning the whole health care team. They disclose to the family and work through the issues together. It appears that the number of claims filed is less than the national average and their financial outlay is less. It's acknowledging the mistake and saying, “Here's what we're going to do about it.” Some patients say, “I don't want to hear it's not going to happen again — I want to know how you will fix it.”
Q: How do you overcome the cloud of fear about litigation, as one speaker put it, that prevents health care practitioners from acknowledging errors?
A: I'm not sure we're ready to overcome the cloud of fear. Law is adversarial, medicine collegial. Medicine seeks solutions; law seeks remedies to conflict between individuals, so there are a lot of fears out there. There are a lot of gaps in understanding, trust, and expectation. As one speaker said, we need to get everyone in the system involved, but until it's a kinder, gentler system, we are still immersed in the “shame and blame” environment. We're all struggling to move out from under this.
Q: I've heard that some physicians view communications skills as a soft, or touchy-feely topic. How do you get physicians to buy in to learning these skills?
A: Communication is just like any other skill — it's critical and it must be learned. Those who speak on this subject make it “unsoft,” if you will. They make it relevant, practical, with solutions based on plenty of real-life examples. It's also about acknowledging that failures within the system are a primary reason for errors, which can make communication skills education an easier pill to swallow.