Property and Casualty Experience

Workers CompensationDenial of medical and indemnity benefits to

injured employees when the insurer cannot defend the case leads to attorney involvement, litigation, higher settlement value and increased expenses.

Auto BI and General LiabilityFailure to admit liability and resolve the

situation leads to increased case costs, attorney involvement, possible trial, and increased expenses.

What Warrants Apology & Disclosure?

ApologyApology is given regardless of error or negligence

when an unexpected situation happens. Express sympathy for injured person and family members.

DisclosureIf the patient becomes aware of an error, even if no

harm is done – disclosure is needed. If an error did not reach the patient but patient/family

suspect something wrong, you may need to disclose.

Initial Disclosure & ApologyApologized for the event, but do not accept

blame or spread blame. Empathy only! State only what you know to date.Promise a thorough investigation and

pledged to communicate and keep patient/family in the loop.

Fix initial problems & concerns such as phone calls, food, lodging, etc.

Initial Disclosure & Initial Apology“We are sorry this happened.”“We are going to do a fair and

through investigation. We will keep you advised.

Obtain contact information for patient and family.

Help with phone calls, food, lodging, clergy, etc.

Three Step Disclosure Process

Step 1 - Empathy and good customer service.

Step 2 – Investigation.Step 3 – Resolution.

STEP 1 Initial Disclosure

Its about empathy and establishing trust and communication with patients and families right after an adverse event happens.

Providers say "sorry" but no fault is admitted or assigned. Providers take care of the immediate needs of the patient/family (food, lodging, counseling, etc) and promise investigation.

The goal is to make sure the patient/family never feels abandoned.

STEP 2

Investigation Discovering the truth. Was the standard

of care breached, or not? Involve outside experts and move swiftly

so the patient/family does not suspect a cover-up.

Keep in close contact with the patient & family throughout the investigation.

Investigation (step 2)Involve independent and impartial outside experts.

Move quickly – Investigate Medical Center in 72 hours or less.

Stay in contact with patient & family.

STEP 3

ResolutionShare the results of the investigation with the patient & family, counsel, and discuss.

When Investigation Shows ErrorRoot cause analysis shows standard of care not

met. Then error(s) or negligence exists.Set meeting with patient, family, and attorney.Apologize and admit fault.Explain what happened and how it will be fixed.Discuss compensation.

Investigation Shows NO ErrorRoot cause analysis shows standard of

care was met – no negligence exists.Still meet with patient, family, and attorney.Empathize, answer questions, open

records – prove innocence.No settlement will be offered and

any lawsuit will be contested.

Three Main Goals1. Compensate quickly and fairly

when inappropriate medical care causes injury.

2. Defend appropriate medical care.3. Reduce patient injuries (and

therefore claims) by learning from mistakes.

Program ImplementationEducate physicians, nurses, technicians &

administration.Make them aware of program and who to call

when something happens.Get them to buy into the idea and start to

change their culture.Focus on customer service.Discuss prior success stories regarding Apology

and Disclosure.

Select Team and TrainTeam:

Risk managersAdministrationSenior physicians and nursesAttorneys

Training :Train-the-trainer Review scenarios & cases that had favorable

resultsCommunication trainingCustomer service

Good customer service sets the stage by creating trust

between providers and customers.

end….