Posted by: ayrshirehealth | January 15, 2014

The power of “apology” by @di962

Apology

DictionaryThe oxford English Dictionary states that Apology means; “to acknowledge and express regret for a fault without defense.” This definition captures the core elements of apology:

a) acknowledgment,

b) affect, and

c) vulnerability.

Why is it then that “sorry seems to be the hardest word” (Elton John)?

When one of my sons was younger he was assaulted by a gang of youths, the injuries he received required him to undergo surgical treatment. His assailant was caught and found guilty and asked to participate in a programme of restorative justice. This was something that myself and my son agreed to. We really wanted the assailant to understand the impact of the assault on his life and our lives as a family and for him to say sorry and hopefully for him to change his ways and not do this to another child. However despite spending about 9 months on this programme of restorative justice he never said sorry.

So why did “sorry” never happen?

I believe it was because the assault was a willful and reckless act with intent to harm and the assailant did not reach a place where he was able to identify why he committed the act and therefore he was not able to acknowledge his part in my son’s pain and suffering.

Thankfully, in healthcare willful and reckless acts are so rare, seen only in cases like Shipman, most often the harm we are looking at is due to unreliable systems and processes and related human factors.

feedback1Causes that can to a large extent be remedied.

Over the past week I have been looking at some complaints received by the organisation from patients who have been harmed either physically or psychologically or let down by the care they received. The definition of apology has therefore frequently been on my mind.

In the cold light of day, without all the pressures that the clinical teams face, I look at the responses and don’t always see the key tenants of apology.

Why is this?

CourtIn healthcare there has been a long held belief that saying sorry is an admission of responsibility or guilt and that when said it makes it more likely that legal action will be taken.

In our modern NHS this is not the view that is now held, but how do we give our clinicians the confidence and competence to get past defensiveness and fear of blame and enable them to deliver an apology that indicates regret and remedy and identifies reasons without being defensive?

ConversationIn the busy life of a clinician it is often difficult to have the time to think through the full impact on a patient or their family when something goes wrong.  The event may on the face of it seem quite small but the impact may be massive to the patient and or their family.

That impact will never be conveyed if there isn’t a conversation where the patient can describe the impact and the impact will not be understood by the clinician if they cannot place themselves in the patient and or families shoes.

Empathy and compassion are key, with the primary focus of compassion being the alleviation of suffering. When a clinician is able to understand the impact from a place of empathy and compassion, the apology that follows becomes authentic and much more readily accepted. It is always right and appropriate to say “I apologise that this has happened to you”.

Candour

If a clinician knows that an action or omission by him/her has led to harm it is completely appropriate to disclose this and to follow with regret that this has happened and what can and will be done to remedy the situation.

The Medical Defense Union state it is their experience that “a well considered sincere apology can resolve complaints and disputes at an early stage”. http://www.themdu.com/guidance-and-advice/latest-updates-and-advice/top-5-new-years-resolutions http://www.themdu.com/press-centre/press-releases/be-honest-with-patients-who-suffer-preventable-errors-mdu-reminds-doctors

Several studies in America have also now demonstrated that the act of apology makes it more likely that cases are settled. Full Disclosure of Medical Errors Reduces Malpractice Claims and Claim Costs for Health System Agency for Healthcare Research and Quality Honesty is the best policy: UMHS approach to medical error & malpractice spreads beyond Michigan Liability Claims and Costs Before and After Implementation of a Medical Error Disclosure Program Annals of Internal Medicine, August 2010

How can we support clinicians to gain the skills needed?  

There are many programmes around aimed at developing skills in relation to handling complaints and adverse events but not too many that are designed around developing the empathy and compassion required to apologise effectively.  My offer to the organisation is to develop a programme that will do just that and support our clinicians to apologise effectively and deliver what our patients and families want; regret, remedy and reasons that are not defensive.

This week’s blog  was by @di962 (Diane Murray), Assistant Director of Clinical Improvement and Clinical Workforce at NHS Ayrshire & Arran.

Please feel free to make comment on this or any other of the Ayrshirehealth blogs.

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Responses

  1. […] tackled one of the tough issues in the public sector on the Ayrshirehealth blog this week: The power of “apology”. She looked at why “sorry seems to be the hardest word” in the National Health Service, […]

  2. Really heartened to read this as it’s an approach that is long overdue…for too long we’ve tried to explain what has happened to patients rather than apologise and resolve

  3. Read bit more about this and apparently up to 95% of customers will give you a second chance if you handle their complaint successfully and in a timely manner……encouraging! Good starting point #complaints



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