The doctor approached the patient, a woman who had been diagnosed with cancer, and said something many physicians are not accustomed to acknowledging:
“We made a mistake. I am sorry.”
Because there had been a nine-month delay in testing, the patient’s cancer likely had gotten worse. Her treatment would be more invasive and intense. She would require chemotherapy.
In this scenario, the patient was an actor who works as a simulation patient at Christiana Care’s Virtual Education and Simulation Training Center. The doctor was Kathleen McNicholas, M.D., JD, medical director of Performance Improvement. Both were playing roles at a CANDOR symposium presented in March during National Patient Safety Week.
Introduced in September 2015, CANDOR (Communication and Optimal Resolution) advances Christiana Care’s culture of patient safety by supporting patients when an analysis and event review confirm unexpected patient harm.
“Christiana Care is a pioneer in transparency,” said Stephen Pearlman, M.D., MSHQS, Quality & Safety Officer, Women & Children’s service line. “We started this journey two years ago when we were one of three health systems invited by the Agency for Healthcare Research and Quality (AHRQ) and the Health Research and Educational Trust of the American Hospital Association in a demonstration project to develop educational resources and tools for CANDOR.”
Dr. McNicholas and Dr. Pearlman, in collaboration with Patient Safety and Risk Management, are leading this approach, which seeks to be transparent and maintain open communication with patients and families while supporting the emotional needs of or patients, families and staff.
“We are committed to analyzing what happened and developing strategies to prevent the event from happening again,” Dr. Pearlman said. “We will share this information with the patient and family as part of the process.”
A total of about 80 participants attended one of two three-hour sessions, including frontline staff, community and employed physicians, charge nurses, assistant nurse managers, vice presidents, service line participants, Pastoral Care, Language Services, resident physicians, fellows, Patient Relations and Patient Experience staff.
Featured speakers were nationally recognized experts in communication about and disclosure of medical errors that lead to patient harm: Thomas Gallagher, M.D, professor and associate chair in the Department of Medicine at the University of Washington; and Bruce Lambert, MS, professor in the Department of Communication studies and director of the Center for Communication and Health at Northwestern University.
Dr. Pearlman noted that a swift and sure reaction to unexpected events is a crucial part of the process.
“The timing of when we find out about these events is critical,” he said. “If we don’t find out until days later we already have lost something. There isn’t the same degree of trust than if we talk to patients and families right away.”
Once an event is reported Christiana Care takes a streamlined approach, with Patient Safety and Risk Management working together to evaluate the event.
“Patient Safety, under the leadership of Michelle Campbell, vice president for Patient Safety, and Chris Carrico, director of Patient Safety and Accreditation, and Risk Management under the leadership of Brenda Pierce, corporate counsel, and Susan Perna, director of Risk Management, were integral to the process of developing the CANDOR program,” Dr. Pearlman said.
In the simulation, Dr. McNicholas and the actor demonstrated how the process can work.
“The assignment was to meet with the patient and talk with her about a medical error that caused her harm, which is our duty as ethical physicians,” Dr. McNicholas said. “I want to apologize for what happened, listen to her, inform her that a review would be completed and that we would share our findings and steps to prevent this from happening again.”
When physician and patient first met the patient was hostile and angry.
“I went to shake her hand and the patient withdrew it,” she said.
After an open and caring conversation, the patient accepted the doctor’s apology. She trusts that the appropriate steps will be taken to prevent similar events in the future.
“She was able to forgive,” Dr. McNicholas said. “She had gotten what she needed.”
Attendees also had the opportunity to ask questions at the symposium.
“This is a big culture change that we are asking people to make, and events like the symposium help to promote CANDOR within our culture,” Dr. Pearlman said.
“This is The Christiana Care Way, truly being respectful, expert caring partners in our neighbors’ health, and our commitment to safety and patient experience.”