Beyond Disclosure: Supporting Patients after Errors

Disclosure of medical errors has been a hot topic for the risk management community for at least the past decade, as hospitals and healthcare facilities have been moving toward becoming more transparent and recognizing the needs of patients and caregivers after medical errors. The medical community has also embraced and encouraged disclosure, as evident by the many policies and guidelines available, including those from the American Society for Healthcare Risk Management, National Quality Forum, Institute for Healthcare Improvement, and Massachusetts Coalition for the Prevention of Medical Errors.

A brief survey of Healthcare Risk Control (HRC) members conducted in April 2013 found that the great majority of respondents (approximately 89%) had a disclosure policy in place. However, disclosure is difficult and complex—needing much more than policies and procedures to change the healthcare culture so that it is natural for clinicians and hospitals to acknowledge, make amends for, and learn from errors. It is therefore essential to take a look at this process and ask: Is disclosure being done correctly? *

_______________ * While this article discusses many of the issues involved with disclosure, a comprehensive discussion about how to develop a program, as well as policies and procedures, is available in the Guidance Article Disclosure of Unanticipated Outcomes. _______________

While there has been much progress, many patients and those in the field would argue that there is still significant work to be done. For example, one study, which evaluated cancer patients’ reactions to disclosure, found that the majority of those surveyed felt that “most” of the four common elements of disclosure (explanation of what went wrong, acknowledgement of responsibility, apology, and commitment to prevent recurrences) were missing (Mazor et al.).

Other studies and anecdotal reports have found that patients and their families are often frustrated when they try to engage hospitals and healthcare workers after an error, showing that some organizations may still prefer to keep errors hidden. (Duclos et al.; Van Spall; Welch) Patients and their families have also reported feeling isolated and...