Patient / family. A need for damage control. A need to restore cordial relationship.

Transcription

1 Restore patient relations conflict resolution and apply mediation for better patient and staff relations. Adverse events 74,400 to 1,243,200 / yr 98,000 death / yr 1 in 10 patients is harmed International Forum on Quality and Safety in ealthcare: Asia Singapore, 28 September 2016 D4: Manage Adverse Event Dr. LUI Siu Fai, M JP Clinical Professional Consultant Division of ealth System, Policy and Management The Jockey Club School of Public ealth and Primary Care 8th leading cause of death 3 rd leading cause of death Approx. 43 million adverse events occurred each year around the globe 23 million associated disability-adjusted life years Adverse event A distressing, sad and difficult situation for everyone. Patient / family Staff / organization (department / hospital) Physical / psychological harm Distress, Confused Sad, Angry Mis-Trust hen an adverse event occurs, we need to, and must, manage the Adverse Event in a much better way to minimize the harm and distress for everyone patient, family, staff & the organization. A need for damage control. A need to restore cordial relationship.

2 I. Definition TE PATIENT AND FAMILY EXPERIENCE II. Communicating with the patient III. Support of the patient and family IV. Follow-up care of the patient and family TE CAREGIVER EXPERIENCE V. Support of caregivers VI. Training and education MANAGEMENT OF TE EVENT in the aftermath of serious clinical adverse events, patients, families, staff, organizations, and communities will all say, 2006 VII. Elements of a hospital incident policy VIII.Initial response to the event IX. Analysis of the event X. Documentation XI. Reporting e were treated with respect. hen an adverse event occurs, we need to, and must, manage the Adverse Event in a much better way If not, distress and anger will lead to complaints and all the aftermaths, including legal battle / litigation. Prevention of complaint is better.

3 Guideline principles Just and fair to all (staff and patient) Benefit of doubt to staff Be a Responsible organization Clear error admit, take responsibility Inadequacy acknowledge Not an error - hold position Incident Management (key elements) Be responsive. Be responsible. That everything can be done to put things right is done (reassurance: need to be done, will be done). Be connected / communication. Establish trust with patient / relatives Incident Management (pre-incident) Culture Open Just Proactive Trust (on same boat) Preparedness Policy / protocol Response team Incident (Adverse Event) Management 1. Prompt response 2. Assessment / Reporting 3. Communication / Open disclosure 4. Support patient/family & staff 5. Investigation / Analysis 6. Risk reduction solution 7. Action to reduce risk 8. Sharing and Learning 9. Legal issues, mediation 10. R issue Immediate actions Follow up actions SF Lui CUK JCSP&PC

4 Incident Management (immediate actions) 1 1. PROMPT ACTION Recognize a problematic case Seek help and support (from senior) Minimize harm (prevent secondary event) DAMAGE CONTROL Incident Management (immediate actions) 2 2. Assessment / Response Gather information (sequence of event / evidence) Preliminary assessment + Convene a Rapid Response Team ospital management, Department staff, PRO, CRO Decide on a position to take: can just acknowledge an AE first, without position Reporting / Notification Serious case (harm, death): Call seniors, ASAP Other cases: Routine channel Incident Management (immediate actions) 3 Incident Management (immediate actions) 4 3. COMMUNICATION OPEN DISCLOSURE - To patient / family AE has harm or affected the patient. - To public Serious AE causing harm / death & potential media interested event. 4. SUPPORT Patient / relatives see to their needs and concerns less angry, less emotional patient / relatives less complaint, easier Patient relations Staff (a second victim) Department (staff sentiment)

5 Open Disclosure is a key component of Incident Management, which must be managed. Pre-existing Culture and preparedness for AE (crisis) are important UK National Patient Safety Agency Framework, Principles, Policy, Process Strengthening Being open - by supporting staff - through board leadership - supporting resources Acknowledging, apologising and explaining when things go wrong; Conducting a thorough investigation into the incident and reassuring patients, their families and carers that lessons learned will help prevent the incident recurring; Providing support for those involved to cope with the physical and psychological consequences of what happened Canadian Disclosure Guidelines 2015 ARQ CANDOR Guiding principles Importance of Disclosure A few ords on ords (avoid the use of Error ) Building the Foundation Support patients, staff Just culture The Disclosure Process A word on Apology saying sorry Implementation Guide for the CANDOR Process Communication and Optimal Resolution Toolkit

6 OPEN DISCLOSURE Organisation s Perspectives A responsible organisation Y E N O O A T Y A formal and transparent policy and process of open disclosure and management of AE Cordial relationship Support patient / family Support staff Less litigation (No allegation of a cover up) Professional s Perspectives Patient s Perspectives Y Professional obligation Ethical duty Integrity, onesty Second victim Needs help Relief after Open disclosure Y Need to know Right to known To be informed of everything good or bad is a key component and expectation of good patient relationship Trust (To be told of the truth)

7 Open Discloure Patient/family s needs & sentiment A T Current condition Intervention to minimize the harm Provide factual information Care plan Follow up plan Remain engaged / regular update Contact persons / support (PRO) Express sympathy / regret / Apology + Express responsibility O Established dialogue Support the family See to their needs Being considerate Offer little things (that is feasible) (medical record copy) Offer direct contact (mobile phone) Attending funeral Offer to meet family to review RCA finding Good communication and management of adverse event may reduce anger / anxiety => PREVENTION OF COMPLAINT But inevitably, some situation cannot be resolved amicably Management of Conflict Negotiation Mediation Arbitration Litigation Violence A need to MANAGE COMPLAINTS IN / IN FOR ALL

8 MEDIATION 調解 Alternative Dispute Resolution A structured process whereby two or more parties to a dispute attempt by themselves, on a voluntary basis, to reach an agreement on the settlement of their dispute with the assistance of a mediator : US Rush Medical Center in Chicago A Prototype for ADR US Pew Mediation and ADR Project prototype Pennsylvania Conflicts are destructive, as both disputants are suffering: the doctor for the accusations he/she perceives as unjust, the patient (or their relatives) for the harm he/she attributes to low performance of the healthcare organization. Besides, they stop any communication with each other. The transformative mediation approach allows parties to meet and express those values, points of view and feelings which nourish their conflict, without any involvement of the judicial authority. Successful mediation allows healthcare organizations build-up citizens trust and to preserve their good reputation and may reduce costs, when a damage request is expressed.

9 Despite overwhelming evidence that suggests that patients, families and health care systems benefit from offering appropriate disclosures and apologies to patients and families in the aftermath of medical errors, few health care organizations in the United States invest in consistent systematic training in disclosure and apology. Using a narrative analysis, explores the cultural barriers in the United States health care environment that impede health care providers from engaging in restorative conversations with patients and families when things go wrong. SINGAPORE STAGE 1: Issues management at healthcare provider level STAGE 2: Escalation Ministry of ealth Singapore Medical Council Nursing Board Dental Council MO oldings Pte Ltd, ealthcare Mediation Scheme

10 ealthcare Plenary: Mediation in ealthcare The increasing number of medical malpractice litigation exerts high social costs as doctors feel pressured to resort to defensive medication and as higher insurance costs are inevitably transmitted to consumers. Mediation plays a vital role not only to address these macro concerns but also to give patients and caregivers the care and closure they need after a treatment or outcome did not meet expectations. ow hospitals, doctors, lawyers, patients, and insurance representatives can leverage on mediations to satisfactorily address parties key concerns. Adverse event / outcome Complaints ong Kong Society for ealthcare Mediation Dispute Conflict Litigation Pre-court Communication Negotiation Mediation (formal)

11 Prevention is better than cure Prevent escalation of complaint is better than to resolve it Formal Mediation Apply mediation skill Adverse event / outcome Complaints Dispute Conflict Communication Negotiation Applied mediation skill Pre-court Litigation Mediation (formal) Day to day business / dispute Patient / Relative Applied mediation skill Staff Incident, complaint management Mediator 有傾有講有商有量 Staff / ard Manager (Front line staff & management) TEAM EAD/DOM/COS (Department level) Patient / relative Staff ard Manager (Front line management) TEAM EAD/DOM/COS (Department level) PRO / ead of PR Department (ospital Management Level) Conversation, Talk Discuss, Seek solution

12 1. Empathy 2. Anger Management 3. Active Listening 4. Questioning 5. Paraphrasing 6. Reframing 7. Summarizing 10 Applied Mediation Skills 8. Interest behind the position 9. Options Generation (BATNA/ATNA) 10. Breaking the impasse Informal Mediation Process Model (PRO) Preliminaries (with hospital staff / patient & relative) Opening statement by the mediator Expressof issues / concerns by the 2 parties Setting the Agenda (identify the common ground and identify the issues of disputes) Exploration stage find out interest behind the position facilitate mutual understanding exchange of ideas generate options that are acceptable (IN /IN) Communication Skill Training for healthcare staff 1. Better Patient Communication Basic communication skill 2. Effective Patient Communication Enhanced communication with mediation concept 3. Challenging Patient Communication Advanced communication with apply mediation skill 4. Mediation course Better Patient Communication Basic communication skill For frontline A staff Effective Patient Communication Enhance communication with mediation concept alf day forum of A frontline staff OT TEATRE 高溫劇場

13 Challenging Patient Communication Advance communication with applied mediation skill Full day workshop for A mid-level staff Mediation course Formal mediation course -> accredited mediator 40 hours course for staff involved with patient relations andling conflicts and complaints hen an adverse event occurs, we need to, and must, manage the Adverse Event, to minimize the harm and distress for everyone patient, family, staff & the organization. Better care, Better communication Engage the patient / relatives in conversation Restore trust To prevent / reduce complaint via Applied mediation skill in conflict resolution. Mediation (formal) for legal case.