Is “Deny and Defend” the Best Practice?

Could what Lambert and McDonald propose as a solution be something police could adopt?

Read it and let me know what you think.

“Sometimes, when errors are egregious or there is intense media scrutiny, as in the case of the misdiagnosis and death of Texas Ebola patient Thomas Eric Duncan, hospitals eventually apologize and make financial settlements. But without media attention, routine harm resulting from errors still typically receives the ‘deny and defend’ response.

“Such behavior has failed to make the U.S. health care system safer or more humane for patients and families.

“The good news is better alternatives may now be available.

“This past week’s announcement of President Barack Obama seeking $6.2 billion for Ebola-related funds from Congress — including $2.4 million for the U.S. Department of Health and Human Services — demonstrates that many feel the Ebola crisis will likely continue to stress the US healthcare system. In doing so, the situation will reveal many of its flaws and weaknesses.

“Every day in every hospital in America, health professionals make mistakes that harm patients. The frequently cited estimate from the Institute of Medicine’s 1999 report on medical error was that 98,000 Americans die each year from medical errors. A 2013 estimate from the Journal of Patient Safety put the number of deaths due to preventable harm at 400,000, with perhaps 10-20 times more people being seriously but not fatally harmed.

“From the perspective of patients and families, the typical hospital response prevents access to the truth. It also denies them a chance to tell their stories, denies them an apology when they deserve one, and denies them an opportunity to reach rapid and equitable out of court settlements.

“Such an approach is anathema to learning and improving. It promotes secrecy about the individual and systemic causes of medical errors and substandard care, makes it impossible to identify and learn from patterns of error, and leaves us defenseless against present and looming health threats.

“A 2010 study in the New England Journal of Medicine showed that American hospitals are not getting safer, and one of the main obstacles to improvement is the lack of transparency promoted by this ‘deny and defend’ mindset…

“In our research on communication and resolution approaches to malpractice, patients and families who have been victims of medical errors tell us that without hearing an explanation or apology, every hour that passes after the initial harm event feels like an additional injury.

“Fortunately, there is now a viable alternative.

“Several hospitals around the country, notably the University of Michigan and the University of Illinois at Chicago, have adopted the so-called communication and resolution approach to unexpected patient harm.

“This approach emphasizes rapid reporting of harm events, rapid communication with patients and families, and rapid investigations to identify possible system failures and to determine whether or not the patient was harmed by inappropriate care.

“When an investigation reveals inappropriate care, the health professionals who were involved meet with the patient and family, admit liability, describe in detail what happened, apologize and offer emotional support, and maintain contact for ongoing communications.

“Depending on the nature and severity of the harm, the hospital will often waive fees and charges related to the care that caused the harm, waive fees for subsequent care to remedy the harm, and offer financial settlements to compensate patients and families for pain and suffering and for the cost of ongoing care — all without litigation.

“Research shows that communication and resolution programs have many benefits. Those include fewer claims and lawsuits, increased reporting of near misses and errors, more rapid settlements for patients, lower malpractice insurance costs, lower legal fees and expenses for hospitals, and less defensive medicine being practiced by physicians.

“More importantly, telling the truth to patients after they have been harmed by medical errors is the right thing to do. It is more just, equitable, and humane.

“It is better for providers too, who are often traumatized by unintentionally harming the people they were trying to heal, and who are prevented from apologizing, and even speaking, to patients and families…

“One of the advantages of a communication and resolution approach to medical error is that its openness facilitates data collection, learning, and process improvement.

“Make no mistake — it is not enough to tell the truth to patients after we harm them. Our primary objective must be to harm fewer people by making health care safer. Although we do not always know precisely how to make care safer in the short term, we know it will require openness and transparency to support learning and process improvement…

“’Deny and defend’ has become an indefensible approach to medical error. The time has come to abandon it.”

I only wish that this article would first have come from a police leader. The concept proposed by Drs. Lambert and McDonald is sound and, as I have mentioned in the past, the threat of liability in the wake of an organizational mistake (and often the cautioning by government attorneys, has often kept police leaders from doing what they know is the right thing to do!

To read their full article, CLICK HERE.