Improving open disclosure in Dutch hospitals

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1 Improving open disclosure in Dutch hospitals Kiliaan van Wees and Lodewijk Smeehuijzen/VU University, Amsterdam

2 Introduction Previous research project Open Communication and Compensation following adverse Medical Events (Finalized 2013) = Tomorrows plenary presentation of Lodewijk Smeehuijzen A follow-up project aiming at fostering open disclosure First thoughts on pilot design!!!

3 This presentation Background Open Communication and Compensation -study/follow up project Dutch context Some key findings and recommendations from the Open Communication and Compensation -study Further steps (a pilot design)

4 Argument/motives in favour of disclosure Prerequisite for improving patient safety Satisfies a patient s principal needs and may prevent further emotional harm Prevents that recovery care or harm-reduction will be withheld from the patient Fits in with care providers belief that there is a moral duty to be open about errors Disclosure may also reduce the emotional and psychological consequences of the incident for the doctor Disclosure may prevent unnecessary juridification!

5 Ethical and legal standards in The Netherlands Responsibility to disclose medical errors (and support patients) is (more explicitly) being incorporated in a growing amount of ethical and legal standards; Dutch Medical Association guideline (Dealing with incidents, errors and complaints) Code of Conduct Open Communication after Medical Incidents; Better Handling of Medical Claims (GOMA) Draft Bill Quality, Complaints and Disputes in Healthcare Act (Wkkgz)

6 GOMA (Code of Conduct Open Communication after Medical Incidents; Better Handling of Medical Claims) Care provider will contact the patient as soon as possible and in any event within 24 hours after the incident was discovered The patient will be clearly informed about the facts and circumstances of the oncident as soon as these are known and, to the extend possible, in a manner compatible with the needs and wishes of the patient. If the investigation into the facts and circumstances of the incidents show that an error was made, the care provider will acknowlegde this error and apologize to the patient

7 Decision Central Medical Disciplinary Tribunal (10 september 2013) Open and pro-active approach after a serious medical incident is part of the professional standard Doctors must take initiative Careful preparation Ongoing process (not a single event)

8 Draft bill Quality, Complaints and Disputes in Healthcare Act (Wkkgz) Currently under debate in the Senate (First Chamber) Article 10 subpar. 3 Wkkgz: The care providers must notify the patient without delay about the nature and the circumstances of a medical incidents with (potential) noticeable implications for the patient. Furthermore this must be reported in the patient medical file, including time and date of the event and the names of the persons involved. The care provider also informs the patient about the possibilities to mitigate the consequences of the incident.

9 Patient complaint officers in Dutch hospitals Virtually all hospitals have one or more complaints officers Informal handling of complaints No legal basis Substantial differences Pro-activity Personal skills and authority Contacts with members of the board Only supporting patients or doctors as well

10 Draft bill Quality, Complaints and Disputes in Healthcare Act (Wkkgz) Article 15 Wkkgz: Care providers must appoint one or more suitable persons who On request provide advise and support patients in lodging complaints Explore the possibilities to come to a solution

11 The disclosure gap Patients involved in a medical incident want: An explanation of what happened (and how and why) Acknowledgement that something went wrong and apologies Clarity about the implications for their health To be told how future incidents and errors will be prevented Compensation of damages Studies into the experiences of patients who were reveal a practice that to put it mildly falls short of the ideal

12 Important barriers for open communication Fear of repercussions (loss of reputation, disciplinary measures or liability) Being uncertain how to disclose Psychological hurdle to talk about ones own mistake

13 Some key recommendations Hospital management should stimulate open disclosure Disclosure coaches should be available to assist clinicians in communicating with the patient. Someone is appointed who directs the open disclosure process as well as someone who functions as designated contact person for the patient (this may well be the same person).

14 Some key recommendations An open communication standard/protocol should be developed, preferably on a national level Such a standard/protocol should likely include an Obligation for care providers to provide support to both patients and doctors Obligation for doctors to approach the disclosure coach

15 How to get there? Top down approach seems problematic (lack of commitment from umbrella organizations) Seems to be strong momentum for a bottom up approach Coalition of the willing Open disclosure active hospitals Medical insurers Legal assistance insurers

16 Further steps (work in progress) Exploring and mapping best practices in the Netherlands Interviews with key persons in the chain of incident and claim handling Identify conditions and challenges for successfully improving open disclosure within a Dutch context

17 Further steps (work in progress) Options for pilot-interventions in hospitals Incorporation of open disclosure in medical incident protocol (for example obligation to approach a disclosure coach) Awareness and training sessions Disclosure coach for doctors Peer clinician model? Complaint officers model? The challenge of measurement; how to validate effectiveness?

18 Thank you!

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