Ill Repute: Maintaining Your Good Name in Adversity

 
 
 
 - Richard C. Boothman, JD
Richard C. Boothman, JD, Executive Director of Clinical Safety, University of Michigan Health System in Ann Arbor
Source: University of Michigan Health System
 

“It takes many good deeds to build a good reputation, and only one bad one to lose it.” So said Benjamin Franklin and his words still ring true today. Can cardiologists and providers rebound after a slip? A health system administrator and two cath lab directors share tips on how to face negative events head on and apply key principles that will help preserve good will and restore a damaged reputation. 

How do healthcare providers build and maintain a good reputation? And how do they repair their reputations after a damaging incident? According to the Public Relations Society of America, the three most important factors that contribute to regaining a good reputation after a damaging incident are transparency, responsibility and effective problem-solving. 

Transparency & responsibility

  Before-after Claims & Costs

University of Michigan Health System in Ann Arbor, reported decreases in the number of claims, resolution time and costs when it changed its method for responding to patient injuries and malpractice claims in 2001. Between 1995 and 2007:

The average monthly rate of new claims decreased from 7.03 to 4.52 per 100,000 patient encounters;

The average monthly rate of lawsuits decreased from 2.13 to 0.75 per 100,000 patient encounters;

Median time from claim reporting to resolution decreased from 1.36 to 0.95 years; and

Average monthly cost rates decreased for total liability, patient compensation and noncompensation-related legal costs.

Source: Ann Intern Med 2010;153(4):213-221

Typically when a cardiologist has a poor outcome and reports it to a medical liability insurer, the physician is instructed to limit discussion of the problem with the patient, and to be careful not to concede error. Doing so will encourage the patient to file suit and will weaken the physician’s defense, according to traditional thought.

The deny-and-defend tactic has ill-served healthcare providers, says Richard C. Boothman, JD, a trial lawyer who spent much of his career defending physicians in malpractice actions and who currently serves as executive director of clinical safety at the University of Michigan Health System in Ann Arbor. He asserts that an institution that supports a culture of hiding mistakes or wrongdoing cannot effectively monitor itself, and therefore cannot effectively address compliance, or most importantly, patient safety issues.

Srihari Naidu, MD, the director of the cardiac cath lab at Winthrop University Hospital in Mineola, N.Y., advocates for a proactive approach. He holds and documents a family meeting before all high-risk procedures. His purpose is to make sure that everyone who will be involved in the process understands the potential risks and benefits and has an opportunity to prepare for all possible outcomes.

Naidu will delay a procedure a day or two if necessary to ensure that all appropriate family members are in the room for the family meeting. During the meeting, he tries to convey that the patient’s treatment and recovery are a team effort that requires the cooperation and informed participation of everyone on the team—and that Naidu himself is a member of the team, not just the “procedure-doer.”

This approach benefits his reputation, he says, especially when the result is not as good as had been hoped. “If the patient has a complication, then I can go to the patient and the family and say, ‘You remember, this is one of the things I was concerned about,’ and it becomes a simple conversation, because I have already done the hard work at the family meeting,” Naidu explains.

Full disclosure is necessary to honor the trust that must guide an appropriate physician/patient relationship, Boothman adds. The University of Michigan’s experience shows that trust can be regained when a hospital creates a culture of acknowledging errors, he claims (ACHE Frontiers 2012; 28:13-28). 

In an effort to settle claims in a speedier and more predictable fashion and to improve patient safety, Boothman and his colleagues in 2000 developed a process of responding to medical errors and patient complaints that utilized experienced nurses as risk managers to review and investigate all unanticipated outcomes. These risk managers discuss all such situations fully with patients and families, and provide explanations as far as they are known. In cases of true error, the patients receive an apology and compensation. When the situation reveals an opportunity for a change in systems or processes to prevent a recurrence,