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Message from Leadership: Transparency... Always

Published August 18, 2014

By Joanne Roberts, MD, Chief Medical Officer

As a physician, if I order the wrong lab test on a patient, do I tell him? What if I order an MRI of the head when I meant to order an MRI of the hip? What if I were to remove the gall bladder instead of the appendix? What if I amputated the wrong limb?

In the last case, there is no question that patients need to know the truth. Historically, it has not always been so simple. But as healthcare matures in our quest to deliver safe care every time it really is simple.

As people of Providence, we are on a journey to help make our organization more reliable every day—eliminating errors in all that we do. But we know even the safest industries are not perfect. Errors, although bad, provide a chance to learn from our mistakes so we are equipped with more knowledge for the next patient. One of the best ways we can learn from our errors is by being transparent– every time, with every patient.

Lucian Leape is a pediatric surgeon and is known around the world as the senior statesman for safety in healthcare. For Dr. Leape, safety begins with transparency. He argues that whenever an error occurs – small or large – the first action is to tell the patient.

First, it is the right thing to do. “The patient has a right to know what happened. Just as patients are entitled to know all the results of laboratory tests, opinions from consultants, risks of treatment and alternative therapeutic options, they are entitled to know what the causes of the breakdown are when things go wrong. It is also what each of us would want for ourselves.”

Second, disclosure heals – both the patient and ourselves. “The incident damages the patient’s trust. If it is not openly and honestly dealt with, trust is irrevocably destroyed and the patient will be psychologically scarred for life. Trust is based on truth. If there is silence, or dissembling, or incomplete information (partial “truths”), trust crumbles.”

Nobody likes to make mistakes, but speaking honestly to our patients helps us heal, too. At Providence, we have adopted principles of Just Culture. Just Culture challenges the idea that people should be punished for making mistakes. The fact is, healthcare is difficult. We should strive to do everything in our power to eliminate errors but we are human and owning up to our mistakes is humbling.

The final aspect of transparent communication is that it reduces the risk of costly malpractice lawsuits. Studies in Michigan, Colorado, and the VA System all show that open disclosure (and apology) for errors results in fewer malpractice lawsuits and less payout when suits do occur. In my mind, that evidence reflects the trust that begins to be rebuilt when we are transparent as soon as we discover an error.

I am proud of the work we do today. I have heard nurses telling patients about a “near miss” and doctors telling families about a lab test that was incorrectly ordered. As we move forward in this journey to eliminate harm, we owe it to one another to recognize that errors will occur. We need to recognize that we are all here to do the same thing– to heal. And we need to support one another when sitting down with patients to be open and honest about everything, every day.