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» A magazine for and about Oregon Community Hospitals.
Providing modern medical care is a complicated undertaking. Sometimes, despite
everyone’s best intentions, things do not go as planned, and the outcome of care is
very different than the doctor or the patient expected.
Across the U.S., some hospitals have been experimenting
with a new way to respond when a patient may have been
harmed by the care they received. These hospitals have
implemented Communication and Resolution Programs
(CRPs). CRPs provide a patient- and family-centered
response to patient harm events and close gaps in care. A
hospital with a full-featured CRP has systems in place so
that any time a patient is harmed, the following things will
happen:
•
Providers will report what occurred to hospital
leadership so there is an opportunity to address and
learn from the event.
•
The patient and family will receive immediate
emotional support and a commitment from the
hospital to share information about the event as it is
known; they may offer the family immediate assistance
with short-term expenses (e.g. lodging during the
patient’s extended hospital stay).
•
Health care providers and staff affected by the event
will receive emotional support, ideally from their peers,
recognizing that everyone suffers when care doesn’t go
as intended.
•
A hospital team will investigate the event to learn
what happened, why it happened, and whether it was
preventable.
•
The hospital will make system changes to prevent harm
to future patients.
•
Information about the event will be shared with
patients and families so they won’t feel the need to
contact lawyers for assistance in getting information.
If the event was preventable, or the hospital is not proud of
the care it provided, the hospital will provide compensation
to the patient and family without a legal battle
CRPs reflect the values of health care. Hospitals and
providers have a mission of helping patients, and work hard
to develop trusting relationships with them. Patients and
families expect that relationship of trust to continue even
when things have not gone as planned. The breakdown in
communication that can follow when a patient has been
harmed by medical error betrays that trust and compounds
the damage.
The CRP approach has some obvious advantages. In hospitals
with CRPs, the relationship between the hospital and the
patient and family is maintained and even strengthened,
as the hospital immediately provides emotional support
and commits to keeping the family informed. CRPs also
protect future patients: by investigating, and promptly
addressing any safety risks, the hospital makes it less likely
that another patient will experience a similar event. Clinical
staff benefit from the support of their peers and are given
Facts and Feelings
Medical professionals excel at facts: instrument readings,
time lines, medication dosages. Patients and families want
empathy: they want to know that their medical providers
understand their feelings of fear and powerlessness, grief
and loss. They also want information, but making an
emotional connection is primary. Expressions of empathy,
such as “I can only imagine how difficult these last few
days must have been for you,” are always appropriate.
Until a hospital has completed their review of the event to
understand what happed and why, they may not have the
facts to respond to more detailed questions right away.
A COMPASSIONATE
RESPONSE TO PATIENT HARM
By Beth Kaye & Valerie Harmon