By: Diana Taibi Buchanan and Sarah E. Shannon
It’s impossible to discuss patient safety without bumping into the Institute of Medicine’s 1999 report, To Err is Human. This publication shone a harsh light on high prevalence and serious consequences of medical errors:
- Physical and psychological discomfort to patients and families;
- Costs from addressing the effects of errors (e.g., treatment, extended hospital stay) and lost income totaling between $17 and $29 billion per year;
- Reduced morale among health workers;
- Eroded trust between providers and patients.
One of the many steps taken toward reducing medical errors has been the enhancement of teamwork. Although team enhancement strategies aim to reduce errors, healthy teamwork can provide intermediate improvements in health care delivery. The truth remains that, despite progress, medical errors persist. In a health system that values quality and social accountability, errors must be addressed in transparent manner that engages patients and families as members of the health care team.
To strive toward reducing the negative outcomes of errors for patients and the health care team, an interprofessional team at the University of Washington launched an annual training program. This program, which was part of an initiative funded by the Josiah Macy Jr. Foundation and the Health Resources Service Administration, is now part of a Fundamentals for Interprofessional Practice Curriculum at the UW. Each year, students from across the health sciences participate in this error disclosure workshop.
Students first view a short introductory video to learn the scope of the problem of medical errors, understand barriers to disclosure, and become introduced to strategies for overcoming these barriers. Such barriers include…
- Fear of legal consequences,
- Belief that patients don’t really want to know,
- Lack of faith in one’s own skills to disclose errors effectively.
The training addresses each of these points. The former two are addressed quickly with simple facts. Regarding fear of litigation, students are informed that there are legal protections in many states for offering a personal apology to patients. Regarding the second point, there is research evidence demonstrating that patients do wish to be informed of errors. Finally, the skills deficit is addressed through a 2-hour in-person training session that emphasizes the key components of effective error disclosure: accurate and full Information, an apology, and sincerity in delivery of this message.
The students were divided into small groups of 15-18 people and then interprofessional teams of 3-4 people. Two faculty worked with each small group– one as the general facilitator, one as the actor to whom the error was disclosed. Students from each profession were given slightly different descriptions of the case. They first discussed the case, each profession bringing its unique role and understanding, to discern the full picture of what had happened. Students then planned and delivered the disclosure in their small interprofessional teams to the faculty who was playing the role of a family member. To challenge the students, a slightly different twist was added each time. For example, the family member might be sad one time and angry the next. Each small group performed the disclosure and had a short debriefing. The entire group participated in a reflective debriefing at the end and received feedback from the faculty playing the family.
In the four years we have offered this workshop, it is consistently viewed as valuable by the students. As a faculty facilitator, I have observed that the error disclosure feels surprisingly real and stressful to students, but they state that they are glad to have participated. The value of the exercise is not only in the students having the practical skills to disclose an error, but experiencing the actual discomfort of delivering this difficult news. Thus, students enter the workplace with the practical and emotional skills to make error disclosure a real part of their practice when needed. While we all hope that there will one day be no errors to disclose, until then, preparing students to engage patients honestly, respectfully, and as a team is a service we as educators must provide to health care.
The InCITE Error Disclosure Toolkit is available here.
To Err Is Human. http://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf
AHRQ, Patient Safety Primers: Error Disclosure. http://www.psnet.ahrq.gov/primer.aspx?primerID=2