Organization commitment a key to improving safety and health equity

In the overall push to keep patients safe, the use of a comprehensive risk management solution can help support better care for all patients.

“Everyone agrees we want to be honest with families when harm happens, but how do you do that?” asks Ryan Solomon, vice president and general counsel for Arkansas Children's Hospital, an organization striving to provide safer care to its pediatric patient population.

There’s no clear answer, but we do know prioritizing transparency after an adverse event is more of an art than it is a science.

When harm happens, clinicians have historically been trained to deny and defend. A comprehensive risk management solution process helps health systems support their clinicians compassionately and holistically after an adverse event and respond with increased transparency and honesty to patients and their families.

The heart of risk management

A comprehensive risk management solution trains health systems to start with a conversation that happens immediately after an event in which harm occurs. This conversation is purely focused on disclosure of the adverse event – telling families and the patient what is known, what is unknown and what the organization is doing to find out what is unknown.

Solomon of Arkansas Children’s notes that this step is crucial to building trust with patients and families and is a surprisingly simple way to begin the process because so much is still unknown. However, simple does not mean easy. These are difficult conversations that take skilled and practiced communication, supported by comprehensive risk management solution training and mock conversations to prepare.

This first conversation stands as a promise that the conversation between the health system and the patient has begun and will continue.

Doing the right thing takes courage

Situations when a harm event has occurred, but a family is not positioned to be a strong advocate – for example, a family on Medicaid who is unlikely to pursue litigation – are some of the situations where using a comprehensive risk management solution takes the most courage.

To strive for more equitable access to quality healthcare, Arkansas Children’s, whose patient population is overwhelmingly insured by Medicaid, is practicing transparency and authenticity with every family regardless of background or payer.

Even when the health system has not yet determined whether the adverse event was preventable, Arkansas Children’s executives have decided that beginning the conversation with the patient and family is always the most ethical decision.

At the core of it, when families pursue litigation, they aren’t really seeking money – they’re looking for the truth. Arkansas Children’s reported that their patients and families list money as a third or even fourth incentive.

Knowledge is power

Striving to improve health equity is honorable, but difficult to do without specific and consistent data to identify patterns and make improvement decisions. Arkansas Children’s is in the process of breaking down their event analysis by race, ethnicity, language and socioeconomic status.

More equitable care begins with clean data. Collecting that data requires staff who feel comfortable asking patients to share their identities in a way that builds trust with the patient and families, a skill that can be learned through a comprehensive risk management solution.

Correctly identifying people is the only way to effectively quantify adverse event data and connect it to health outcomes of various vulnerable populations. Having access to this data empowers organizations to provide equitable access to quality care to achieve a better, safer patient experience.

This cultural shift doesn’t happen overnight – but it is possible.

This work takes time. Solomon’s advice to others who are considering embarking on this journey is to “expect to have missteps, expect to have disagreements, expect to have the fortitude to do what’s right for your patients and your families.”

Not all social determinants of health can be governed by a health system – but where we do have an opportunity to make an impact, it is our collective responsibility as an industry to provide a more equitable and safer patient experience, a safer workforce environment and an overall safer organization.

Timothy B. McDonald, MD, is chief patient safety and risk officer at RLDatix.

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