Remember the scene in the movie "Patch Adams" when Robin Williams looks through his medical school record and finds he's being expelled in part for "excessive happiness?"
The movie character is patterned after a real physician whose iconoclastic approach to patient care and clown-like sense of humor were not looked upon favorably. Yet, his most
important audience - his patients - seemed to get well faster and fully supported his belief in the healing power of laughter and happiness.
Now comes the U.S. Department of Veterans Affairs with a new risk management strategy - extreme honesty. A Dec. 21 article in Annals of Internal Medicine outlines
this new litigation risk reduction strategy: Keep the patient in the information loop aggressively and constantly, no matter what. And especially when mistakes and errors occur.
Humanistic Risk Management
For the first time, a credible organization has adopted a strategy designed to reduce liability, litigation and threats to reputation. Furthermore, the strategy has the
potential to validate something virtually every ethical PR practitioner seeks to do - deal honestly, openly and fairly with various constituencies, especially when bad things
happen. In the paper's abstract, the authors discuss what they call "humanistic risk management." This includes "early injury review, steadfast maintenance of the relationship
between the hospital and the patient, proactive full disclosure to patients who have been injured because of accidents or medical negligence, and fair compensation for injuries."
The abstract continues: "The financial consequences of this type of policy are not yet known; however, one Veterans Affairs medical center (Lexington, Ky.), which has been
using humanistic risk management since 1987, has had encouragingly moderate liability payments. The Department of Veterans Affairs now requires such a policy for all of its
facilities; therefore, comprehensive experience may be only a few years away."
Victim Management
The greatest barrier to disclosure and appropriate victim attitude management is an institution's fear of liability. This is usually fostered by well-meaning, but misguided
counsel. Any credible way to reduce or mitigate this fear is essential to better behavior, reputation management and litigation reduction.
A lawyer's first assumption (now well ingrained in management) is that total honesty and candor in situations of error and negligence will only lead to higher liability. But
the data in this article tend to refute that, indicating that the liability performance of the Lexington facility is better than other comparable facilities that rely on secrecy,
denial and even deception.
The article also cites a study published in The Journal of the American Medical Association in 1992 that examined why families sued their healthcare providers for
perinatal injuries: "Of 127 families who sued, 43 percent were motivated by the suspicion of a cover-up or by the desire for revenge. Another study of 149 randomly selected
patients in an academic internal medicine practice found that almost all the respondents 'wanted their physicians to acknowledge even minor errors'; many stated that they would
respond to an unacknowledged moderate or severe mistake by filing a lawsuit."
One lawyer interviewed for the article put it this way: "In over 25 years of representing both physicians and patients, it became apparent that a large percentage of patient
dissatisfaction was generated by physician attitude and denial, rather than the negligence itself. In fact, my experience has been that close to half of malpractice cases could
have been avoided through disclosure or apology but instead were relegated to litigation. What the majority of patients really wanted was simply an honest explanation of what
happened, and if appropriate, an apology. Unfortunately, when they were not only offered neither but were rejected as well, they felt doubly wronged and then sought legal
counsel."
If you simply substitute the word "victim" for "patient" in this article, you have the basis for a major lesson in reputation preservation for your organization.
To request reprints of the Annals of Internal Medicine article, "Risk Management: Extreme Honesty May Be the Best Policy," contact Steve S. Kraman. M.D., Veteran's Affairs
Medical Center, 2250 Leestown Road, Lexington, Ky 40511, 215/351-2657.
James E. Lukaszewski, APR, Fellow PRSA, is a specialist in helping clients
deal with sensitive situations including litigation communications and reputation
management. He has an international practice and teaches crisis management strategy
at New York University. For more information, check out his Web site at http://www.e911.com.
Extreme Honesty: How This Policy Works At the V.A.
1. In instances of malpractice , the chief of staff calls the patient's family and asks them to come to the medical center for an explanation. The phone call indicates,
if necessary, that a medical mistake was made and that an attorney may accompany the patient or family, if desired.
2. The family meets with the chief of staff, facility attorney, quality manager and other personnel. Details, including the identities of persons involved in the
incident, are provided as sensitively as possible. Emphasis is placed on the regret of the institution, and on any corrective action that was taken to prevent similar events.
Offers of restitution - along with subsequent medical or surgical treatment - are made.
3. V.A. staff provide claims assistance to the patient and family in filing forms. The victim receives contact information for other support services. The medical center
is forthcoming with the plaintiff's attorney. The facility's attorney and the patient's attorney work together to reach an equitable settlement on the basis of "reasonable
calculation of loss."
James E. Lukaszewski, APR, Fellow PRSA, is a specialist in helping clients
deal with sensitive situations including litigation communications and reputation
management. He has an international practice and teaches crisis management strategy
at New York University. For more information, check out his Web site at http://www.e911.com.