Creating a New Culture of Communication
By Barry C. Dorn and Joan E. Roover

The professional life of a health care executive is filled with constant negotiations involving the different, competing constituencies within the system and beyond. There is a constant stream of problems and issues requiring solid communication and negotiation skills. No communication is more important than communicating bad news to patients.

The new JCAHO Patient Safety Standards include a Disclosure Standard that sets forth the expectation that hospitals and physicians will inform patients and families when an “unanticipated outcome” results in harm or injury to a patient.

Coincidentally, there is a medical malpractice crisis of major proportions looming in the country. It has already swept through several states and is gaining momentum. Physicians and hospitals cannot continue to absorb the increases in insurance premiums; physicians are leaving states where the insurance premium increases are reaching crisis proportions. Although physicians fear that disclosure will increase the number of lawsuits, the new JCAHO standards may actually help to address the problems in the medical liability system and decrease the number of lawsuits.

The creation of an early intervention mediation program can be an effective alternative to the current system of lawsuits that contributes to the exponential increase in liability insurance premiums. By bringing together a neutral mediator, who has an understanding of health care and its culture, with a potential plaintiff and hospitals and caregivers, it may be possible to resolve the human emotions and the need for information that contribute to the filing of a lawsuit.

Mediation has been used to resolve certain types of consumer complaints made to the Massachusetts agency that licenses physicians. In the experience gained from this process, three recurring needs of injured parties were identified. First, patients and their family members want an explanation of what happened and why it happened. Second, they want an apology or acknowledgement from the provider. And third, they want to know that a change has been made to ensure that what happened to them will not happen to someone else. Physicians, initially skeptical, often leave mediation feeling they have learned something significant from seeing their practice “through the eyes of the patient.” Physicians often make changes in their practice to create a safer, more sensitive patient care experience. Physicians also appreciate the opportunity to explain what happened and why, express their feelings about the error, and convey an acknowledgement or apology to the patient. Litigation cannot accomplish any of this, but mediation can.

As hospitals and physicians begin to implement the new JCAHO standards, we can make patients our partners in increasing patient safety. Mediation can facilitate education, communication and healing in a way no lawsuit can.