Why hospitals should apologize after harming patients

By Evan M Benjamin, MD, MS, FACP

Last week, the president of the parent organization of Somerville Hospital near Boston apologized in person to the husband of Laura Levis, who died outside the hospital two years ago after finding an emergency room entry locked.

“I’m very sorry for what happened to your wife….I take personal responsibility for this.” Chief Executive Patrick Wardell told Peter DeMarco.

“It’s good to finally hear you say those words,” the still grieving husband replied.

The apology happened at The Boston Globe offices, with cameras rolling, and came only after DeMarco, a journalist, spent months investigating the true circumstances of his wife’s death and published the harrowing details in a long Boston Globe Magazine story that has gone viral.

It should never have come to this.

Two years ago the hospital leadership knew there were grave system failures that contributed to her death. Hospital officials had never told him the truth. He found out through police reports and other records that Laura had stood right outside the doors of the Emergency Room unable to get in as she died from an asthma attack.

Hospitals — and, in fact, any corporation — are, by nature, reluctant to take responsibility for errors and harm. Litigation and malpractice loom large. However, as physicians and care providers we have a greater responsibility to transparency, learning and accountability.

There is a better way.

Communication, Apology and Resolution (CARe), sometimes called Apology and Disclosure, is an approach that has been piloted around the country. These approaches all share the notion that when patients experience a medical error or injury, they need to be told transparently about what occurred. This “communication” is to come clean and share what was known. This approach stresses that the sharing should be not only to the patient, but also within the system so that preventable mistakes are not repeated. The CARe approach also involves apologizing and moving quickly to fairly compensate patients and families. CARe retains trust, improves learning and strengthens health systems in the long run. And, recent research has shown that the CARe approach does not result in more lawsuits, and may reduce claims and lower defense costs.

CARe has been used by many hospitals in the US including the University of Michigan and six others in the state. In Massachusetts, we have a statewide alliance (www.MACRMI.info) to spread this model as an alternative to the traditional “deny and defend” risk management strategy. Under “deny and defend,” hospitals withhold information hoping to avoid being sued. The result is tremendous suffering by patients and families — as we saw with DeMarco and the Levis family — inadequate accountability for errors and less effective learning. In my experience as a doctor, the providers suffer as well from the guilt, shame and regret, and that suffering is only multiplied when they are prohibited from talking to their patients and families. When patients do finally figure out the harm they suffered was the result of error, they feel betrayed and angry, and believe that the only path to get an apology and information is to sue. Years of expensive legal depositions and battles with results that rarely offer families the closure and healing they most often are seeking. When hospitals use the CARe approach, respect, healing and learning are possible.

Ariadne Labs, a health care innovation center at Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, is teaming up with the Collaborative for Accountability and Improvement to develop metrics and improvement strategies to help health systems create and improve Communication and Apology Programs. Doing this right requires a rethinking of patient safety and risk management at health systems and a commitment to true patient- centered communication and resolution. It needs to be comprehensive for ALL cases of harm and not just the ones where the error is well known.

Communicating, apologizing and learning from error is the future of true malpractice reform.

When hospitals are more proactive, dignity and respect can be maintained and a great deal of suffering can be avoided.

Evan Benjamin, MD, MS, FACP, is the chief medical officer of Ariadne Labs and former co-chair of the Massachusetts Alliance for Communication and Resolution After Medical Injury and a national leader in spreading CARe strategies to health systems across the U.S.