Medical Error Disclosure: Best Practice?

Hello readers!

I am an MHA student at the University of Washington. Currently, my classmates and I are studying medical error and how to best address the issue. There is a great amount of literature that points to medical error as a problem in the U.S. healthcare industry. Certainly, we can all agree, both in and out of the professional world, that "errors" do happen. The question is, how do we best deal with the problem? There are two sides to this issue. First and foremost, how do we prevent medical errors from happening and second, what do we do when our efforts at prevention have failed us?

Many experts agree that healthcare is a team effort and that medical errors are often the result of some failure in the system. (one of my professors at UW thrives in the systemic environment!) A UW mini medical school video http://www.uwtv.org/programs/displayevent.aspx?rID=4086&fID=841 identifies 8 main causes for medical error. Clearly, the problems identified here all happen in different parts of the system. This means that failure happens at different stages in the chain of care. Therefore, a series of errors in the care delivery chain generally has to happen prior to what we call "a medical error".

One of the tools I use to assess the risk of systemic errors in an organization, and therefore prevent them from happening, is the DEPOSE Organizational Analysis Model by C. Perrow. You can find the article in "Decision Making, Conflict & Technology," in Complex Organizations: A Critical Essay, 3rd ed., New York, NY, McGraw-Hill, Inc. Perrow guides us through the true nature of systemic breakdown by revealing how multiple small errors (that on their own are harmless) in a linear delivery system can lead to significant problems. Perrow also draws distinctions between centralized and decentralized decision making and how the locus of decision making affects the intended outcome of the system.

Once we tackle the question of "why" errors occur and the "how to" of prevention we are still faced with the question of what to do when our best efforts have failed us? According to Dr. Mengert and Dr. Gallagher, full disclosure is the best practice. Even this poses some questions. When I watched the simulation in the above mentioned video, I likened the experience to one of poor service in a restaurant. As a recipient of poor service, my first thought would be, I KNOW I won't be paying for that 100 units of insulin OR the trip to the intensive care. I thought of how angry I would be if I got a bill for those "services" and how likely it is that I would. OUCH!

I'm sure that we all assume that providers who make errors absorb the costs of the unnecessary "services rendered" during the course of those errors. But, is there anyone who is ultimately responsible for making absolutely certain that those who are the vicitims of error are not billed in additon to being on the receiving end of poor service? Adding insult to injury is something I know that I want to avoid at all costs!

In a restaraunt, the manager generally gives you your meal for free or some other kind of compenstion when the service is less than adequate. This is done to maintain your patronage. I think it strange that, after hearing numerous conversations around the topic of medical error, the only "compensation" that anyone seemed concerned with was a law suit. In a restaraunt a customer would most likely refuse to pay for poor service. However, there are several reasons why compensation, other than a law suit seem unfeasable. One of which is the fact that insurance pays most people's medical bills so a "free" stay in the hospital never even seems to come to most people's minds.

The fact that people rarely consider a free medical service as having any immediate value points right to one of the reasons healthcare costs have climbed so exponentially over the last few decades. Because of the reimbursement system we have in the U.S., people have historically been somewhat immune to rising costs. This seems to be the case in the wronged patient. The is made evident by the lack of people seeking "a reckoning" for poor service. But, there have got to be better ways of compensating individuals who have been the recipients of poor healthcare service than litigation!

I thought about what I might like in exchange for poor healthcare service. Would a free hospital stay do it for me? An appology? hhmm . . . After pondering the subject, I decided that I would want charity service be given to someone who needed it in the exact dollar amount that my insurance company would have paid for my care. Yes, a direct relationship between the dollar amount in errors and dollar amount in charity care would "right the wrong" in my eyes.

I am now pondering how an incentive plan for "error free" service might reduce the number of errors in a healthcare organization. Many manufacturing plants have the signs, "error free for X number of days." This practice we know is one aimed toward reducing workman's compensation claims. Might we employ the same strategy in a patient care setting? Something to ponder.

Thanks for reading and please post your thoughts or comments.