CARe and PFAC:

1. CARe and PFAC: How patient input helped BIDMC’s Communication, Apology, and Resolution program to succeed Health Care For All Webinar March 12, 2014

2. BIDMC’s PFAC • Started in 2010 • Composition: 17 patient/family advisors, 6 staff • Invite staff to present and welcome staff to request the opportunity to present • Strategic “in-reach” to staff working on quality and safety issues • Goal: Align work of PFAC and work of hospital

3. What is Communication, Apology, and Resolution? A transparent and honest approach to adverse events. Components of CARe: • Culture of Safety, including encouraging reporting • Communication with patients when things go wrong • Empathy and apology • An apology of responsibility will be given if there was an error. • Timely and fair injury compensation outside of the court system • Attorney representation is encouraged • Improvement of systems and practices through learning from adverse events, and reporting the improvements to harmed patients

4. What is MACRMI? • MACRMI: The Massachusetts Alliance for Communication and Resolution following Medical Injury • An alliance of patient advocacy groups, hospitals, their insurers, and statewide provider organizations committed to transparent communication, sincere apologies and fair compensation in cases of avoidable medical harm. BIDMC is a member of this organization. www.macrmi.info

5. MACRMI Membership

6. PFAC’s Work for CARe, 2013 - 2014 • Assist in developing our CARe Patient Brochure • help clarify CARe’spurpose • find an appropriate tone • determine ways that it could be more helpful to patients • Review our Patient Best Practices Document • ensure that the Best Practices describe how patients would want to be treated after an adverse event • create consistent clarity and tone in the document • Assist in redesigning the required Massachusetts DPH SRE letter templates • help us understand possible patient reactions to these required letters • improve the letters to better serve their purpose

7. CARe Patient Brochure • Purpose of brochure: To help patients better understand what CARe is, and how it works. • Audience: Patients in general, but mainly those who have experienced an adverse event. • PFAC’s Contributions: • Greater emphasis on communication • Clarify the “decider” in each step of the process • Clarify how to initiate the process if you’re a patient • Clarify legal rights • Elimination of the word “money” • Addition of clearer “bulleted” formatting throughout

8. The CARe Patient Brochure Front Cover Inside Flap Back Cover

10. CARe Best Practices for Patient Interaction • Purpose of the document: to make it clear that patients are an essential part of the CARe process, and to guide CARe sites in how to best work with patients who have been harmed. • Audience: Staff at CARe sites (and potential sites) • PFAC’s Contributions: • Simplify the language, and bold important points of practices so that staff can read quickly and easily. • Add a separate practice that focused on Listening.

11. Revised Best Practices Soon to be on our website: www.macrmi.info

12. State-Required DPH letters for SREs • Massachusetts health care facilities are required to send letters to patients at 7 and 30 days after an event, if they experience what the state calls a Serious Reportable Event (adverse events that are seriously harmful to patients such as hospital acquired infections, wrong site surgeries, falls, etc.) • Audience: Patients who have been harmed • Purpose of the document: to ensure that patients are fully informed about adverse events they experienced

13. PFAC’s Contribution to the DPH Letters • Reframe each letter entirely! • Human First – we are telling you because we are committed to being transparent and to treating you like a human being, not because we’re required to by law. • Bigger concerns • Discussion first • Reopening the wound • Transfer of personal information

14. New DPH 7 and 30 Day letters • Rewrote both letter templates entirely, based on feedback • Now in use at BIDMC, with future expansion to our affiliates • Associate Commissioner of the DPH reviewed and really liked them, and appreciated our joint effort

15. PFAC Member Perspective • Appreciate the concept of apology without blame. • Able to give insight regarding how a patient might view the situation. • Thrilled there is a forum for patients who feel something has been done that deserves attention but may not want a suit. • Makes the institution more human and the patients feel more respected.

16. Questions? • Contact information • Pat Folcarelli, Director of Patient Safety • pfolcare@bidmc.harvard.edu • Melinda Van Niel, Project Manager, CARe/MACRMI • mvanniel@bidmc.harvard.edu • Elana Premack Sandler, Project Leader, Patient and Family Engagement • epremack@bidmc.harvard.edu • Holly Thomas, PFAC Member • zubsha@gmail.com

17. How Can PFAC’s Get Involved? • Ask your organization how it’s currently handling communication following medical harm. • Ask to see the letters that they are mandated to send out to patients. Maybe you can provide improvement • Find out how they are providing emotional support to patients and families following harm. Let them know about MITSS • Ask if they are doing early compensation on cases meet criteria. • Ask if they have any PFAC members who are assisting in the Root Cause Analysis (RCA).