1. The Sorry Works! Coalition

2. Quotables “I would never introduce a doctor’s apology in court. It is my job to make a doctor look bad in front of a jury, and telling the jury the doctor apologized and tried to do the right thing kills my case.” - President, South Carolina Trial Lawyers Assoc.

3. Quotables “For decades, lawyers and risk managers have claimed that admitting responsibility and apologizing will increase the likelihood of a patient filing a malpractice suit and be used against a doctor in court if they sue. However, this assertion, which seems reasonable, has no basis in fact. There is to my knowledge not a shred of evidence to support it. It is a myth.” - Dr. Lucian Leape, Harvard University in the March/April 2006 issue of The Physician Executive “For decades, lawyers and risk managers have claimed that admitting responsibility and apologizing will increase the likelihood of a patient filing a malpractice suit and be used against a doctor in court if they sue. However, this assertion, which seems reasonable, has no basis in fact. There is to my knowledge not a shred of evidence to support it. It is a myth.” - Dr. Lucian Leape, Harvard University in the March/April 2006 issue of The Physician Executive

4. Quotables “We never sue the nice, contrite doctors. Their patients never call our offices. But the doctors who are poor communicators, arrogant, and abandon their patients get sued all the time. Their patients call our offices looking for answers.” - David Patton Medical malpractice attorney and Sorry Works! board member Works! board member

5. Quotables “Our profession made a grave error when we listened to defense attorneys who told us to abandon our patients after adverse events. This is the chief reason we have a medical malpractice crisis.” - Dr. Jerome Buckley Retired CEO of COPIC Ins. Retired CEO of COPIC Ins.

6. Brief background on The Sorry Works Coalition Formed in February 2005 Formed in February 2005 Diverse board representing all stakeholders in the medical malpractice crisis Diverse board representing all stakeholders in the medical malpractice crisis Advocate apologies and upfront compensation as “middle ground” solution to crisis Advocate apologies and upfront compensation as “middle ground” solution to crisis

7. Our belief The Sorry Works! Coalition believes and advocates that apologies and upfront compensation for medical errors reduce lawsuits and liability costs while providing swift justice for more victims and reducing medical errors The Sorry Works! Coalition believes and advocates that apologies and upfront compensation for medical errors reduce lawsuits and liability costs while providing swift justice for more victims and reducing medical errors

8. Goals of the Coalition Goal #1: Education Goal #2: Organizing the full-disclosure movement Goal #3: Legislative activities, including Sorry Works! pilot programs, mandated training, etc.

9. Educational message Sorry really does work! Sorry really does work! Lexington VA hospital/all VA hospitals Lexington VA hospital/all VA hospitals University of Michigan/Stanford University, and Harvard Teaching Hospitals University of Michigan/Stanford University, and Harvard Teaching Hospitals Kaiser hospitals (28 hospitals) Kaiser hospitals (28 hospitals) Minneapolis Children’s Minneapolis Children’s Catholic Healthcare West (40 hospitals) Catholic Healthcare West (40 hospitals) COPIC Insurance COPIC Insurance And others…. And others….

10. Program description Bad outcome – unexpected death, surgery or treatment did not produce expected results, etc Bad outcome – unexpected death, surgery or treatment did not produce expected results, etc Root cause analysis – several weeks to four months – was the standard of care met? Root cause analysis – several weeks to four months – was the standard of care met? Stay in close contact with patient/family during analysis– return all phone calls promptly and pleasantly Stay in close contact with patient/family during analysis– return all phone calls promptly and pleasantly

11. Program description cont’d Root cause analysis shows standard of care not met = error(s) or negligence Root cause analysis shows standard of care not met = error(s) or negligence Set meeting with patient/family and attorney Set meeting with patient/family and attorney Apologize and admit fault Apologize and admit fault Explain what happened and fix Explain what happened and fix Offer upfront compensation Offer upfront compensation

12. Program description cont’d Root cause analysis shows standard of care was met = no error(s) or negligence Root cause analysis shows standard of care was met = no error(s) or negligence Still meet with patient/family and attorney Still meet with patient/family and attorney Empathize, answer questions, open records – prove innocence Empathize, answer questions, open records – prove innocence “Honesty Dividend” “Honesty Dividend” RUSH variation RUSH variation

13. Sorry Works! Savings Anger reduced = fewer lawsuits, lower settlements Anger reduced = fewer lawsuits, lower settlements Defense litigation costs down; cases closed in months instead of years Defense litigation costs down; cases closed in months instead of years Non-meritorious cases reduced Non-meritorious cases reduced Medical errors reduced Medical errors reduced Happy patients and families don’t bad mouth hospital Happy patients and families don’t bad mouth hospital

14. Addressing doubters Docs will become sitting ducks Docs will become sitting ducks Saying sorry is admitting fault Saying sorry is admitting fault Trial lawyers are too aggressive/courts really awful Trial lawyers are too aggressive/courts really awful Small cases – not big cases Small cases – not big cases Settling and paying cases we could win in court?? Settling and paying cases we could win in court??

15. Important Point “Sorry” alone doesn’t work “Sorry” alone doesn’t work Admitting fault Admitting fault Fixing procedures important and possibly involving patient/family in the process Fixing procedures important and possibly involving patient/family in the process Upfront compensation Upfront compensation

16. “Snow jobs and weasel words” “I shouldn’t be you telling this, but…” “I shouldn’t be you telling this, but…” “I’m sorry this happened to you…” “I’m sorry this happened to you…” “We feel horrible about this….” “We feel horrible about this….” “We’re sorry if you feel that way…” “We’re sorry if you feel that way…” Make patients and families angrier – increase likelihood of lawsuit Make patients and families angrier – increase likelihood of lawsuit Don’t do it!! Don’t do it!! Need carefully planned, well-thought out disclosure events; training needed. Need carefully planned, well-thought out disclosure events; training needed.

17. Legal problem? No. Customer service problem? Yes! Med-mal crisis is really a customer service crisis Med-mal crisis is really a customer service crisis Legal reform not the answer – enhanced communication, problem solving, and rebuilding trust through programs like Sorry Works! the answer. Legal reform not the answer – enhanced communication, problem solving, and rebuilding trust through programs like Sorry Works! the answer.