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