Aside from babies being born, a hospital isn’t usually associated with joyous occasions.
More often, patients are admitted because something is wrong.
And for some, things don’t go as planned.
When that occurs, the experience of sorting out what exactly happened can be as traumatic as the procedure itself. In some cases, family members are left to pick up the pieces after a loved one dies.
Hospitals can sometimes build a wall of denial when things do go wrong. For decades, many have employed a “deny and defend” approach, backed by powerful litigation teams.
But today, a handful of hospitals around the country are using a reverse tactic to deal with medical errors.
It’s a more open and communicative method that focuses on finding out what went wrong and apologizing if the hospital is at fault. Compensation, when warranted, is also part of the deal.
Program at Stanford
For seven years now, Stanford University Hospital has used the program PEARL (Process for Early Assessment and Resolution Learning) as a means to investigate all matters involving “concerning outcomes,” according to Jeffrey Driver, chief executive officer of The Risk Authority Stanford and chief risk officer of Stanford Healthcare and Stanford Children’s Health.
“It was initially focused on personal and financial loss,” Driver told Healthline. “But it’s really about these situations and learning from them. Our overarching goal is make our patients whole and not shortchange them.”
The program encompasses the entire Stanford Healthcare system, including its diagnostic and rehabilitation centers, the two hospitals, and the more than 3,000 physicians.
Today the program boasts what can best be described as two tracks for patients and families to get answers — and compensation.
The first is medical error, what Driver calls their indemnity program. The other is geared toward complications that usually result in compensation of no more than $5,000.
That is called PEARL Care. Patients who use the PEARL process are also not giving up their right to sue the hospital, should they not agree with the outcome.
Patients, nurses, and doctors are all encouraged to report an issue, should they feel it’s warranted in a medical care situation. Once a PEARL file is opened, an internal evaluation is conducted and then sent to an independent outside medical expert for analysis. If the findings aren’t consistent, further expertise will be pursued.
Throughout the process, a patient liaison is in contact with the patient and/or patient’s family, providing updates along the way. Staff has support throughout as well.
Stanford doesn’t release the number of cases that have funneled through PEARL, but they do say that malpractice suits have dropped by 50 percent, defense costs by 24 percent, and indemnity paid by 27 percent.
Stanford is one of a handful of hospitals across the country that has adopted a more transparent form of communication for when things go wrong.
The first of its kind started at the University of Michigan, now known as the Michigan Model.
The University of Illinois, University of Washington, and Bay State Hospitals in Massachusetts all have programs in varying degrees that address transparency, communication, and compensation for patients.
Patient Advocates Want More
It’s estimated that roughly 440,000 people die each year due to preventable hospital error. That makes medical errors the 3rd leading cause of death in the United States.
Programs like Stanford, Bay State, and the University of Michigan are working to improve that number, but they’ve got a ways to go, according to Dr. Julia Hallisy, a San Francisco dentist and patient advocate.
She founded the nonprofit, Empowered Patient Coalition, after she and her husband lost their daughter to cancer in 2000.
But the cancer wasn’t the catalyst for the organization. It was a biopsy procedure that caused their daughter to become infected with staph aureus and develop septic shock.
When Hallisy demanded answers, the staff’s first response was that her daughter must have inhaled the bacteria at the park.
“We had a lot of back and forth, and not a lot of transparency,” she said. “I didn’t know what to do. “
Hallisy said programs similar to PEARL should be all implemented in hospitals over the country, because “these horrific things can happen and you are not in control.”
She applauds the innovation behind such programs but would like to see even more patient-centric practices be put into place. Simple things, like the name “Risk Assessment” — the hospital entity that determines medical error cases and ultimately compensation — doesn’t convey a patient-first stance, she noted.
While it’s true that many hospitals still employ far less communicative practices on the matter of medical error, there is some evidence that the tide is turning.
On February 18, Stanford is holding a conference on how to conduct and implement an effective communication resolution program for healthcare leaders. Driver said the event is sold out.