Thursday, August 27, 2009

Transparency, Disclosures, and YouTube

does anyone else out there get a feeling that the pendulum on public disclosure and transparency is about to swing too far in the other direction .. is this really about doing the right thing for the patient? or is it merely capitalizing on a market trend towards consumerism and transparency?

By Laura Landro

Pitching Patient Safety and Hospital Transparency on YouTube

After a medical error, hospitals’ traditional approach has been to retreat behind a wall of silence, on the advice of risk managers and attorneys. But some hospitals are taking a different approach, fully disclosing medical errors, apologizing and offering financial compensation up front – and inviting patients and families to participate in patient safety improvement efforts. For a look at how one hospital is working with the family of a child harmed by a medical error to improve safety, see my latest WSJ column.

While some experts have warned that the full disclosure approach could lead to more lawsuits and higher payouts the experience of the University of Illinois Medical Center at Chicago suggests otherwise. In 2004, the hospital created a consultation service to help staffers communicate quickly with patients and families about safety incidents; in 2006 that evolved into a policy of full disclosure, apology and a swift offer of financial compensation. Over the four-year period, the number of lawsuits dropped 40% from the prior five years, and there has been no increase in financial payouts, according to chief safety officer Timothy McDonald.

“How we respond to these events defines who we are as individuals, organizations and our professions as a whole,” says McDonald, who is both a pediatric anesthesiologist and a lawyer by training. “Open and honest communication between caregivers and their patients and families starts the process of healing and closure – for both the patient and the caregiver.”

The first step is creating a culture that punishes those who recklessly endanger patients but holds blameless those who are involved in errors linked to flawed systems or products. The 450-bed academic medical center uses a carrot and stick approach, praising staffers who promptly report incidents and penalizing those who fail to do so. Departments that fail to promptly report incidents see a larger share of malpractice premiums assigned to their department budget.

Those changes have led to a doubling of the number of patient safety incident reports to about 2,000 in each of the last two years; about 10% of the incidents caused serious patient harm, leading to 20 full disclosures to patients and families of inappropriate or unreasonable care. Equally important, the program has identified safety gaps that have led to nearly 200 improvements in hospital procedures, according to McDonald, who will report on the program’s findings in an upcoming edition of a patient safety journal.

McDonald and a colleague, cardiac anesthesiologist Dave Mayer, are producing a series of patient safety videos to highlight process improvements following harmful patient events and disclosure. The videos, which will be sold to hospitals for use in patient safety education programs for staffers, also aim to teach patients how they can take a more active role in their care and provide critical input caregivers may miss. The YouTube video embedded in this blog post is trailer for the first video, “The Faces of Medical Error: From Tears to Transparency,” which will debut September 24th at the University of Illinois.

TransparentHealth, that brand name you see in the video, is a for-profit patient safety education company founded by McDonald and Mayer. They say any profits will go to the foundations of the families whose stories will be told in the videos, and to fund the making of the subsequent films. They chose to go for-profit because they were unable to secure funding and saw the need for the videos.

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