The 3Rs Program: The Colorado Experience

Quinn, Richert E.; Eichler, Mary

doi:10.1097/grf.0b013e3181899cc2

Cited by 19 publications

(26 citation statements)

References 3 publications

(3 reference statements)

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“…A number of other accounts of the application of policies with the support of insurers can be drawn upon to examine concrete suggestions for change, at least from the US literature. [156][157][158][159][160] Common to these accounts is a sense of enthusiasm, but also often a charismatic individual driving the process forward. There seem to be fewer of these accounts outside of the US context and we found only one in the UK, which described Liverpool Women's NHS Foundation Trust's approach to embedding quality improvement and patient safety in the organisation.…”

Section: Resultsmentioning

confidence: 99%

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An exploration of the implementation of open disclosure of adverse events in the UK: a scoping review and qualitative exploration

Birks

Harrison

Bosanquet

et al. 2014

Health Services and Delivery Research

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BackgroundIn 2009 the UK National Patient Safety Agency relaunched its Being Open framework to facilitate the open disclosure of adverse events to patients in the NHS. The implementation of the framework has been, and remains, challenging in practice.AimThe aim of this work was to both critically evaluate and extend the current evidence base relating to open disclosure, with a view to supporting the implementation of a policy of open disclosure of adverse events in the NHS.MethodsThis work was conducted in three phases. The first phase comprised two focused systematic literature reviews, one summarising empirical research on the effectiveness of interventions to enhance open disclosure, and a second, broader scoping review, looking at reports of current opinion and practice and wider knowledge. The second phase involved primary qualitative research with the objective of generating new knowledge about UK-based stakeholders’ views on their role in and experiences of open disclosure. Stakeholder interviews were analysed using the framework approach. The third phase synthesised the findings from the first two phases to inform and develop a set of short pragmatic suggestions for NHS trust management, to facilitate the implementation and evaluation of open disclosure.ResultsA total of 610 papers met the inclusion criteria for the broad review. A large body of literature discussed open disclosure from a number of related, but sometimes conflicted, perspectives. Evidential gaps persist and current practice is based largely on expert consensus rather than evidence. There appears to be a tension between the existing pragmatic guidance and the more in-depth critiques of what being consistent and transparent in health care really means. Eleven papers met the inclusion criteria for the more focused review. There was little evidence for the effectiveness of disclosure alone on organisational or individual outcomes or of interventions to promote and support open disclosure. Interviews with stakeholders identified strong support for the basic principle of being honest with patients or relatives when someone was seriously harmed by health care. In practice however, the issues are complex and there is confusion about a number of issues relating to disclosure policies in the UK. The interviews generated insights into the difficulties perceived within health care at individual and institutional levels, in relation to fully implementing the Being Open guidance.ConclusionsThere are several clear strategies that the NHS could learn from to implement and sustain a policy of openness. Literature reviews and stakeholder accounts both identified the potential benefits of a culture that was generally more open (not just retrospectively open about serious harm). Future work could usefully evaluate the impact of disclosure on legal challenges within the NHS, best practice in models of support and training for open disclosure, embedding disclosure conversations in critical incident analysis and disclosure of less serious events.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Resultsmentioning

confidence: 99%

“…85 This person must be seen as someone who is supportive of those who have been affected, not someone who is seeking to play down the incident, obscure the content of information, or protect the medical system or clinicians involved. 156…”

Section: Continuity Of Carementioning

confidence: 99%

An exploration of the implementation of open disclosure of adverse events in the UK: a scoping review and qualitative exploration

Birks

Harrison

Bosanquet

et al. 2014

Health Services and Delivery Research

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“…7 This person must be seen as someone who is supportive of those who have been affected, not someone who is seeking to play down the incident, obfuscate information, or protect the medical system or clinicians involved. 11 Although qualitative studies are not typically used to track performance metrics, such as patient satisfaction or the success rate of an activity, Iedema and colleagues' findings are credible. Firstly, it is unlikely that their sample was biased towards dissatisfied patients.…”

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confidence: 99%

“…12 The COPIC Insurance Company in Colorado, US, has supported full disclosure for the past decade, and has found that effective open disclosure and-importantly-responding to the financial hardships related to a medical incident reduce overall liability. 11 Furthermore, patients who have been hurt by a medical incident but who are not abandoned by their clinician may choose to continue their care with that clinician. The principles of successful open disclosure are known, but the operational details need further work.…”

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confidence: 99%

Improving the disclosure of medical incidents

Pace

Staton

2011

BMJ

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“…There are a few comparable programs around the country, including one of the first established at the Lexington Veterans Administration Medical Center, one at Stanford, and another organized by COPIC, the physician-run nonprofit medical malpractice insurance company of Colorado. 9 Although these may represent ideal situations, it is noteworthy that they have not proliferated, raising the question of what barriers exist to more widespread adoption. What caveats, then, should physicians consider before they offer an apology to an injured patient?…”

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confidence: 99%

Commentary: Physician Apologies for Adverse Outcomes—Beware the Minefields of Mea Culpa

Legant¹

2011

JOP

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The 3Rs Program: The Colorado Experience

Cited by 19 publications

References 3 publications

An exploration of the implementation of open disclosure of adverse events in the UK: a scoping review and qualitative exploration

An exploration of the implementation of open disclosure of adverse events in the UK: a scoping review and qualitative exploration

Improving the disclosure of medical incidents

Commentary: Physician Apologies for Adverse Outcomes—Beware the Minefields of Mea Culpa

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