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A system for informing a patient or an individual identified pursuant to state law that the patient was the subject of an adverse incident. The development and implementation of an incident reporting system. . . [that requires all agents and employees to report]. . . adverse incidents to the risk manager. . . within 3 business days after their occurrence (Florida Statutes, 2014) Details of these sections contain requirements for licensing and training; any specific limitations, definitions of reportable events; and the encouragement of innovative solutions to the problem of medical errors. Additional sections of state law stipulate facility reporting requirements, and requirements that the Agency for Health Care Administration (AHCA) post summary reports a minimum of quarterly on its website. Facility reports are of two types: (1) Code 15 reports, which cover occurrences of eight of the most serious types of adverse events and must be reported to the AHCA within 15 days of occurrence; and (2) annual summary reports of all incidents (Florida Statutes, 2014). In addition, a separate section of state law requires the AHCA to collect data on hospital-acquired infections (Florida Legislature, 2010). While Florida was the first state to publish a hospital-specific report on hospital-acquired infections in 2005, a March 2010 review of state-by-state activities from the Committee to Reduce Infection Deaths (RID) notes that the Florida reports are disappointing due to weaknesses in data collection, detail, and methodology (RID, 2011). In 2011 the Florida Department of Health announced it had received funding from the American Recovery and Reinvestment Act (ARRA) for a Healthcare-Associated Infection Prevention Program intended to help both monitor and prevent HAIs. While current information (2014) on the program’s status is not available on the department’s website, detailed information on Florida’s various programs is available from the CDC (CDC, 2013). In the past decade, the cost of medical malpractice insurance has skyrocketed in Pennsylvania. Physicians in high-risk specialties are reported to have moved out of the state, closed their practices, or retired, particularly in eastern Pennsylvania. Liability insurance companies have pulled out of the state. At the same time, serious medical errors continue to occur. Doctors and hospital officials, afraid of lawsuits and loss of insurance coverage, often stonewall patients and relatives, offering only barebones explanations of serious medical errors. Research shows this situation creates a vicious circle in which frustration, anger, and a search for information often motivate patients or their families to file medical malpractice suits. Against this backdrop, the Project on Medical Liability in Pennsylvania, an independent initiative financed by The Pew Charitable Trusts, developed the Demonstration Mediation and ADR Project in 2002 to explore the value of mediation and open, frank communication about medical errors as a means to avoid bitter and protracted lawsuits. The demonstration project, designed and conducted by faculty of the Columbia Law School in New York, involved three hospitals in eastern Pennsylvania and was based on an extensive review of existing research. Shortly after the demonstration project began, its potential findings gained significance because Pennsylvania enacted Section 308 of the Medical Care Availability and Reduction of Error Act. This law, the first of its kind in the United States, requires hospitals to give written notice to patients or their family after a “serious event.” In effect, the state now obligates health care providers to explain the circumstances and repercussions of serious health complications caused by inpatient medical errors. Taking a comprehensive and innovative approach, the Demonstration Mediation and ADR Project offers four recommendations that hold potential for easing the medical liability crisis while benefiting patients, physicians, and hospitals: Provide communication training to doctors and administrators as part of changing hospital culture from one of defensiveness to one of openness. Create a “consult service” of communication experts within hospitals to help plan conversations with patients and family members and provide emotional support to health care providers involved in errors or adverse events. Offer apologies when appropriate. Offer early, non-evaluative mediation that brings patients or family members together with health professionals to share information and seek solutions. Confrontational litigation is antithetical to meaningful communication after an error or adverse event. Instead of mistrust and anger, patients and survivors need to fee understood and respected. Delay takes an emotional and financial toll on both sides. Timely communication helps physicians and hospitals receive valuable information relevant to patient safety. Both sides can receive emotional gratification from good communication, sometimes leading to non-monetary settlements such as lectures in the patient’s name or improvements in hospital procedures. If a monetary payment is appropriate, it should be paid within weeks or months instead of years, as occurs in litigation. Research shows that ineffective communication with patients — not negligence— puts physicians at greatest risk of malpractice lawsuits. But open communication runs counter to the defensiveness physicians often feel and the virtually uniform advice of attorneys to say as little as possible. In addition, health care professionals often make assumptions about a patient’s concerns instead of listening or take a patient’s words at face value instead of trying to determine the patient’s true meaning. The resulting mistrust, anxiety, and suspicion can easily turn into protracted litigation. Even training sessions that are compatible with busy professional schedules can help overcome these problems by familiarizing health care providers with the complexities of meaningful communication. They learn how to formulate the right. Pew Project on Medical Liability questions, to avoid defensiveness, and to express concern about the issues most important to patients — all techniques that tend to defuse anger. Over the course of his or her career, an individual health care professional will likely be involved in only a few events that require disclosure under the Pennsylvania law. As a result, doctors have few opportunities to practice and develop communication skills in real-life situations. Therefore, hospitals need to form teams of intensively-trained employees adept at communications. These teams serve several purposes: Helping plan the initial disclosure conversation, even when little time is available. Accompanying the treating physician to make sure patients and family members have an opportunity to participate and their concerns are addressed.
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