[Editor's Note, I am guest posting this on behalf of my wonderful colleague Michelle Mello, at the Harvard School of Public Health]
Gridlock in many state legislatures over proposals to reform medical liability by capping noneconomic damages—and growing recognition that caps have only modest success in addressing the problems with the malpractice system—have led health care providers and other stakeholders across the country to think hard about alternative approaches. Alternatives that don’t require the passage of legislation are especially appealing. Attention has focused in the last couple of years on a promising approach pioneered by a handful of hospital systems, including the University of Michigan Health System: “disclosure-and-resolution” programs, or DRPs. In DRPs, healthcare facilities and their malpractice insurers disclose unanticipated care outcomes to patients and their families; investigate and explain what caused them; apologize; and, where appropriate, offer compensation without waiting for the patient to sue.
Early adopters of this approach report remarkable success in reducing liability costs and believe they have markedly improved patients’ experience following a medical injury. But they can’t tell how much of the benefit is attributable to disclosing errors and apologizing, versus offering compensation. Is it the honesty and empathy, or the money, that matters? And if it’s the money, how much is enough to get the outcomes healthcare providers want: reduced frequency of malpractice claims, lower defense and indemnity costs, quicker disposition, improvements in staff reporting of unanticipated care outcomes, and a clinical culture that supports open communication with patients?
A new study that I published with my colleagues, Lindsey Murtagh, Penny Andrew, and Tom Gallagher, in Health Affairs this week begins to answer these questions. We used an experimental survey design to investigate the relative effects of disclosure, explanation, and apology on the one hand, and different kinds of compensation offers on the other, on people’s responses to learning that they were the victim of a medical error. We fielded an online survey in which 2,112 American adults randomly received one of 16 vignettes in which they were informed of a medical error. In all vignettes, a physician and administrator explained how the error occurred, took full responsibility, and apologized. Some vignettes also included an offer of compensation—either waiver of medical bills, limited reimbursement of out-of-pocket expenses, or full compensation—while others included no compensation offer. Respondents answered several questions about how they would react to the disclosure. The survey sample was drawn from KnowledgePanel, a standing, probability-based panel of U.S. adults maintained by GfK (formerly Knowledge Networks). The survey response rate was 65%.
What did we find?