Communicating After a Harm Event: Best Practices
An empathetic conversation about a delay in diagnosis preserves a relationship
Two gynecologists missed an abnormal Pap smear report which resulted in an eight-month delay in diagnosis of cervical cancer of a 44-year-old woman. Once the woman’s primary care physician made the diagnosis, the gynecologists contacted Constellation and reported the harm event. The gynecologists received communication assistance from Constellation’s risk consultants before conducting an empathetic conversation with the woman about what went wrong in the care that led to the delay in diagnosis. Because of the honest and empathetic discussion, the relationship between the woman and the gynecologists was preserved. The woman remains a patient of the gynecology clinic and is currently receiving cancer treatment.
Communicating after a harm event
After a harm event, patients, senior living residents and families need immediate, accurate and empathetic communication. Clinicians and care teams must be prepared to communicate in the crucial moments after an event and then in follow-up conversations over days, weeks or even months.
Opening an honest dialogue has multiple benefits including maintaining trust, giving care teams peace of mind and possibly resolving the event more quickly. An open and straightforward approach is also consistent with ethical and professional responsibilities and fosters continued trust between patients and their health care team. Research shows that poor or no communication following a medical incident can lead to long-lasting loss of trust in the health care system and health care avoidance.1 Julia Prentice et al. at the Betsy Lehman Center for Patient Safety found “substantial persisting emotional harm, health care avoidance and loss of trust in health care” among patients and family members who self-reported an experience with a medical error. This loss of trust can impact a health care organization’s brand reputation and market share, and health care avoidance can cause worsening patient outcomes.
Prepare for conversations
The first step is to prepare involved clinician(s) and care team members to have an initial conversation with the patient or resident and family members following the event. Report the event by signing in to ConstellationMutual.com and if needed, request help from one of Constellation’s claim consultants. Your organization’s Communication Go Team should be alerted and empowered to call together the key involved individuals. The goal should be to prepare for the conversation within an hour of discovery.
The Communication Go Team leader should assess the emotions of the involved clinician(s) and care team member(s) to ensure they can communicate effectively and with compassion. A plan should be established for key discussion points.
During the conversation—best practices
“During the discussion with the patient or resident and family, it’s important to lead with known information about the patient or resident’s current condition, what comes next for medical treatment, who the contact person is for future information and an apology for the situation.”Michael Turturici, Constellation Risk Consultant
Here is a brief sample of what to do and what not to do during a harm event communication.
- Introduce all parties and their role
- Apologize for the situation
- Be truthful
- Listen more than you speak
- Validate patient and family emotions
- Show empathy and compassion
- Discuss follow-up expectations
- Lead with startling or upsetting information
- Rush the conversation
- Compare to other situations
- Argue about facts
- Blame others or speculate about fault
- Minimize feelings or emotions
- Make promises, medically or financially
The HEAL Prepare Toolkit
Constellation’s HEAL Prepare Toolkit will help assess your team’s readiness to communicate following a harm event and then help you get to best practices. The Toolkit includes a unit on communicating after harm events and contains assessments, best practices, sample tools and coaching. Start your journey by taking the HEAL Assessment and then the Action Plan will guide you through the Toolkit’s four units: (1) culture, (2) event response, (3) communicating after harm events, and (4) moving forward. Sign in to ConstellationMutual.com to access the HEAL Prepare Toolkit found in Risk Resources.
Constellation’s HEAL program provides healing benefits for care teams and their organizations because we truly believe that what’s good for care teams is good for business.
1Prentice JC, Bell SK, Thomas EJ, et al. Association of open communication and the emotional and behavioral impact of medical error on patients and families: state-wide cross-sectional survey. BMJ Quality & Safety. 2020;29:883-894. qualitysafety.bmj.com/content/29/11/883.
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