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Presentation2 Presentation2 Presentation Transcript

  • Property and Casualty Experience
    • Workers Compensation
    • Denial of medical and indemnity benefits to injured employees when the insurer cannot defend the case leads to attorney involvement, litigation, higher settlement value and increased expenses.
    • Auto BI and General Liability
    • Failure to admit liability and resolve the situation leads to increased case costs, attorney involvement, possible trial, and increased expenses.
  • What Warrants Apology & Disclosure?
    • Apology
    • Apology is given regardless of error or negligence when an unexpected situation happens. Express sympathy for injured person and family members.
    • Disclosure
    • If the patient becomes aware of an error, even if no harm is done – disclosure is needed.
    • If an error did not reach the patient but patient/family suspect something wrong, you may need to disclose.
  • Initial Disclosure & Apology
    • Apologized for the event, but do not accept blame or spread blame. Empathy only!
    • State only what you know to date.
    • Promise a thorough investigation and pledged to communicate and keep patient/family in the loop.
    • Fix initial problems & concerns such as phone calls, food, lodging, etc.
  • Initial Disclosure & Initial Apology
    • “ We are sorry this happened.”
    • “ We are going to do a fair and through investigation. We will keep you advised.
    • Obtain contact information for patient and family.
    • Help with phone calls, food, lodging, clergy, etc.
  • Three Step Disclosure Process
    • Step 1 - Empathy and good customer service.
    • Step 2 – Investigation.
    • Step 3 – Resolution.
  • STEP 1
    • Initial Disclosure
    • Its about empathy and establishing trust and communication with patients and families right after an adverse event happens.
    • Providers say "sorry" but no fault is admitted or assigned. Providers take care of the immediate needs of the patient/family (food, lodging, counseling, etc) and promise investigation.
    • The goal is to make sure the patient/family never feels abandoned.
  • STEP 2
    • Investigation
    • Discovering the truth. Was the standard of care breached, or not?
    • Involve outside experts and move swiftly so the patient/family does not suspect a cover-up.
    • Keep in close contact with the patient & family throughout the investigation.
  • Investigation (step 2)
    • Involve independent and impartial outside experts.
    • Move quickly – Investigate Medical Center in 72 hours or less.
    • Stay in contact with patient & family.
  • STEP 3
    • Resolution
    • Share the results of the investigation with the patient & family, counsel, and discuss.
  • When Investigation Shows Error
    • Root cause analysis shows standard of care not met. Then error(s) or negligence exists.
    • Set meeting with patient, family, and attorney.
    • Apologize and admit fault.
    • Explain what happened and how it will be fixed.
    • Discuss compensation.
  • Investigation Shows NO Error
    • Root cause analysis shows standard of care was met – no negligence exists.
    • Still meet with patient, family, and attorney.
    • Empathize, answer questions, open records – prove innocence.
    • No settlement will be offered and any lawsuit will be contested.
  • Three Main Goals
    • Compensate quickly and fairly when inappropriate medical care causes injury.
    • Defend appropriate medical care.
    • Reduce patient injuries (and therefore claims) by learning from mistakes.
  • Program Implementation
    • Educate physicians, nurses, technicians & administration.
    • Make them aware of program and who to call when something happens.
    • Get them to buy into the idea and start to change their culture.
    • Focus on customer service.
    • Discuss prior success stories regarding Apology and Disclosure.
  • Select Team and Train
    • Team :
      • Risk managers
      • Administration
      • Senior physicians and nurses
      • Attorneys
    • Training :
      • Train-the-trainer
      • Review scenarios & cases that had favorable results
      • Communication training
      • Customer service
  • Good customer service sets the stage by creating trust between providers and customers.
    • end….