Apology and Resolution

Expressing regret can be difficult in many circumstances. But when it comes to adverse medical events, numerous recent studies suggest it is often the best course of action. Patients who experience medical harm generally want an acknowledgment of how they have been affected and assurance from their provider that actions will be taken to keep the same event or mistake from happening to another patient.

Does Massachusetts have a disclosure and apology law?

Under Massachusetts law, when a health care provider makes a mistake that results in an unanticipated outcome with a significant medical complication, the provider must fully inform the patient and, when appropriate, the patient's family, about the unanticipated outcome. This obligation applies to a wide range of facilities and health care professionals — from physicians and nurses, to dentists and podiatrists.

The law also encourages providers to apologize to patients and to express other forms of concern or regret by making such statements inadmissible in any subsequent medical malpractice litigation over the incident. An exception might arise if the provider who made the statement, or the provider’s expert witness, were to contradict the statement when testifying.

Is there a model we can use for disclosure and apology?

CARe — Communication, Apology and Resolution — is an approach developed by several Massachusetts hospitals and health care organizations as an alternative to costly, lengthy and emotionally difficult lawsuits after an avoidable medical injury. When something goes wrong at a hospital or medical office, CARe can be a good way for the patient to receive information, an apology, support, and appropriate compensation. CARe programs also support learning and improvement and ultimately lead to greater patient safety.

What does a CARe program look like?

CARe programs:

Encourage adverse event reporting of all kinds.
Provide just-in-time coaching for clinicians to help them communicate with patients about adverse events.
Offer a rigorous model to assess and investigate adverse events, and mechanisms to share findings and learn from them.
Support providers throughout the process.
Support patients throughout the process.
Communicate the relevant findings of the investigation to patients, and answer their questions.
In cases where the standard of care was met or the care did not cause the harm, promote clear communication of that conclusion while maintaining empathy for the patient’s injury; in cases where the standard of care was not met, promote clear communication of the mistake and solutions to the patient, together with an apology.
Offer fair compensation, and encourage patients or their families to be represented by counsel whenever compensation is warranted.
Result in comprehensive resolution beyond compensation both through open two-way communication with the patient and efforts to address the patient’s medical and psycho-social needs.
Consider a variety of ways to engage patients in post-event learning, recognizing that often the most important thing to injured patients is being able to help prevent the same mistake from happening again.

How do we implement a CARe program in our organization?

While this may seem a complex undertaking, there are resources available to help. Contact or explore the provider tools available from the Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI), including an organizational-readiness checklist and an implementation guide.