20 Jul Adverse Events: Helping Healthcare Providers Respond in a Relationship-Centered Manner
By Dr. Sandra L. Argenio, MD
Many patients have experienced a loss of trust in their health care delivery system and providers. Patients often embark into care with an assumed trust of the health care system. It is our job to make this a reality. It is also our chance to maintain or lose their trust.
Of the nearly one million Medicare beneficiaries hospitalized in October 2008, nearly 1 in 7 ( 13.5 per cent) experienced an adverse event. (Department of Health and Human Services. Adverse events in hospitals: national incidence among medicare beneficiaries Nov 2010)
A recent article by Frederick Southwick et al in the British Medical Journal titled, “A Patient-initiated voluntary online survey of adverse medical events: the perspective of 696 injured patients and families” provides insight into the viewpoint and experience of patients and families.
The survey asked questions concerning adverse surgical procedures, infections, and adverse medical events. Patients were also given the opportunity to provide narrative comments. Over 400 patients and their family members provided written narratives.
Patients specifically described communication failures. “Both patients and their family members expressed a lack of communication with healthcare providers”
One third of the respondents reported that the healthcare providers who initially cared for them refused further communication following the adverse event. Respondents also said they were met with hostility when they offered feedback to members of the healthcare team.
Why would healthcare providers respond this way? Why do healthcare providers often fail to communicate at a time when our patients may need them the most? Healthcare providers must learn to recognize and respond appropriately and effectively communicate with the patient and their family.
When adverse events occur, healthcare teams also suffer from the unexpected event and the consequences of the adverse event. Many healthcare providers have not had any training in patient and relationship centered communication. They are not prepared to handle the feelings of patients in difficult situations. Nor are they prepared to handle the difficult reactions or emotions that they or their colleagues may experience when an adverse event occurs. Management of teams in crisis through communication training can include training to prepare teams to communicate in a patient and family centered manner.
“A framework and program for disclosure of adverse events can be implemented with a true and transparent partnership between patients and families, physicians and partners, allied health staff and administration.” This program is described in “Relationship-Centered Communication: The Foundation for Effective Disclosure of Adverse Medical Events,” by Dr. William Maples, Executive Director for the Institute for Healthcare Excellence.
Healthcare Providers can learn skills which will allow them to partner with their patients in the best of times and in the most difficult of times. By embracing a patient-centered approach to care, healthcare providers can realize a much better chance of gaining and maintaining the trust of patients and their families.