Malpractice lawyers have long counseled doctors and hospitals not to admit to medical mishaps, much less apologize for them. But the twin imperatives of improving safety and cutting the soaring cost of health care are inspiring a different tack.
Several years ago, the University of Michigan Health System pioneered the Disclosure, Apology and Offer model, in which patients who have been the victim of an error are quickly told, issued an apology and offered a settlement – a stark contrast to the traditional "deny and defend" approach. Since then, legal costs have dropped by 60 percent, and the system has had 36 percent fewer medical claims lodged against it, according to a 2010 study in the Annals of Internal Medicine. Similarly, a 2011 Institute for Healthcare Improvement study found that Stanford University's hospitals save $3.2 million a year by saying "I'm sorry" to aggrieved patients.
"You suck all the air out of the room when you say I could and should have done better – I'm sorry," says Richard Boothman, a former trial lawyer and the Michigan health system's executive director for clinical safety. More important, experts say, being open about mistakes allows hospitals to learn from them. Patients and their families often just want to know why an error occurred and to be assured that the hospital is taking steps to prevent a repeat. Apology policies reflect a growing view that medical harms are usually the result of a bad system, not of a bad doctor or nurse.
At Kaiser Permanente, which serves patients in California, Colorado, Ohio, Maryland and several other states, patients are offered an apology, a description of the events that led to the error, and a commitment to do things differently next time, says Doug Bonacum, Kaiser's vice president for quality, safety and resource management. Specially trained ombudsmen help facilitate the difficult conversations between patients who have been harmed and health care professionals, who themselves may be devastated.
In fact, studies show that physicians who are being sued have significantly higher rates of divorce, depression, heart attacks and suicide, says Alan Woodward, chair of the committee on professional liability for the Massachusetts Medical Society, who helped to spearhead a pilot apology program for hospitals in Massachusetts as an alternative to tort reform. It's too early to gauge the program's impact.
Other states are warming to the idea. Oregon passed a law in March that encourages mediation between hospitals and injured patients and allows doctors to apologize without worry that the apology could be used as evidence in court. So, although a recent Johns Hopkins study found that only 2 percent of U.S. hospitals even inform patients immediately when a mistake has occurred, the tide may soon turn.