| Eliciting patients' and family members’ needs |
▸ Explicitly ask what patients'/families’ needs are. Do not make assumptions—even that apology is desired. ▸ Recognise that although most patients want an explanation, apology, compensation and learning, for many patients, simply being heard is most important and must occur early in the disclosure process.
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| Conducting reconciliation conversations with emotional intelligence |
▸ Time the conversation(s) appropriately.
▸ Although early contact (within 48 hours of the incident) is important, some patients need time to process the incident, necessitating multiple conversations. ▸ The onus is on institutions to follow-up with patients/families who need time to process the incident. ▸ In arranging follow-up communications, elicit what timing works best for patients/families.
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▸ Offer apologies in a manner that maximises their effectiveness in promoting reconciliation:
▸ Offered in person by the clinician(s) involved in the incident. ▸ Offered after the provider has listened carefully to the patient and elicited his/her needs. This may involve not including an apology or offering a culturally appropriate apology or an apology which seeks forgiveness. ▸ Timed according to the patient's needs, but generally not postponed until late in the process. ▸ Includes more than ‘I'm sorry’; explicitly acknowledges the harm and the impact on the patient/family. ▸ Not offered as a substitute for other forms of remediation such as compensation and proof of learning. ▸ Executed skilfully and without coercion.
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▸ Respect cultural differences.
▸ Reflect upon whether the process is culturally sensitive; ask questions as needed. ▸ Ask what a meaningful apology includes in the patient's cultural or religious tradition, if appropriate.
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▸ Avoid insensitive word choices.
▸ Contemplate wording ahead of the conversation, recognising that it is important to patients and can help or harm the reconciliation process. ▸ Refer to ‘patient safety incidents’ instead of ‘errors’. ▸ Replace ‘resolution’ with ‘reconciliation’. ▸ Be open to patients’ differing interpretations of what constitutes ‘harm’ and ‘severity’.
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| Convening the right people to participate in reconciliation discussions |
▸ Ask patients who they want involved. ▸ Include the clinician(s) involved in the harm event, unless the patient indicates this is undesirable. ▸ Include support people such as lawyers and patient relations staff and notify patients of their right to consult a lawyer.
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| Responding to patients and family members who are particularly concerned with preventing recurrences |
▸ In disclosure conversations, share any patient safety lessons learned and actions taken. If the incident is still under investigation, assure patients/families that a review is being done. ▸ If learning takes place over a longer time frame, be proactive about recontacting patients/families to share the patient safety steps taken.
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| Improving reconciliation guidelines |
▸ Strict protocols undermine the objective of tailoring institutional responses to individual patients’/families’ needs. ▸ Use flexible guidelines that distil best-practice principles, ensuring that steps are not missed while not prescribing a ‘one size fits all’ communication approach. ▸ Where necessary, amend guidelines to reflect the above best practice principles. Add (or, if it is already present, emphasise) the ‘being heard’ element of the disclosure process. ▸ Move the being heard element to the first step in the initial and formal disclosure discussions. ▸ Add a step that requires asking patients open questions such as ‘how can we help you?’
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