Admitting Medical Error: Like PEARLs of Wisdom

Physicians have long had strong incentives to not admit medical errors. However, a program in California has demonstrated how a proactive approach to medical error can be the best option legally and financially.

Amid all of the political back-and-forth this election season, one not-so-positive trait of human nature is abundantly clear: Nobody likes to admit they made a mistake, much less apologize for it. It’s true of most politicians, but it’s also traditionally been a problem for physicians, medical practices, and hospitals.

But if breaking from that tradition would result in reducing malpractice lawsuits by 50% and the average cost of individual malpractice claims by 40%, healthcare practitioners would sign on in a hurry.

Well, get out the pen, because those are some of the results experienced by California-based Stanford Health Care since launching its Process for Early Assessment, Resolution, and Learning (PEARL) program in 2008.

“The cases that we’ve litigated since 2008, actually, I can count them on two hands,” says Jeffrey Driver, CEO of The Risk Authority Stanford, a subsidiary of Stanford Health Care and Stanford Children’s Health. “It’s been an overwhelming success for us, driven by doing the right thing by patients.”

Sanity From Madness

Driver came to Stanford in 2004 and inherited an inventory of claims and lawsuits that had been handled by a third-party administrator. He started going through those claims upon arrival, and realized that nothing proactive was being done with these cases. In fact, the standard operation procedure at that time was to deny and defend any matter that came in. And if a plaintiff was able to go the long haul, Stanford would go into a period of discovery that could last a full year. Only then was a decision made whether that case would move forward or it would be settled.

“I looked at the whole thing and said, ‘You know, this is madness for us to be approaching it this way,’” Driver recalls. “Let’s start to rethink things.”

Driver and his colleagues examined two existing programs: one in place at the Veterans Administration in Lexington, KY, which Driver calls the “initial pioneer,” and another in the state of Michigan. The feeling was, “If they can do it, we can do it.” And while they made some mistakes early on, they also experienced some successes.

“Our metrics started to show signs of health,” Driver says. “It was definitely a better approach than deny and defend.”

Just in Time

Initial physician reaction was mixed. Driver explains that there’s a lot of fear around admitting responsibility, and a lot of fear around exposing one’s license and actions by the medical board. But the dean at the time championed the program with the School of Medicine’s 2,000 faculty practitioners, stressing the importance of being more transparent, and standing by their patients when there was an unexpected outcome.

“What we decided to do was each and every case required us to stand by our physicians very closely,” Driver says. “And just like a pearl—every PEARL is unique—every situation is unique, and we have to work with our physicians one-on-one.”

And they do, in a format called just-in-time training. In other words, physicians are not asked to engage in any special training. Rather, the philosophy is Driver wants to hear from physicians if they have a concerning outcome. Make no judgments, other than the outcome is concerning to them, the patient, or to the nurses.

“Give us a call, and we’ll go through it together,” Driver says.

That means everyone is on the same page—the hospital administrator, the involved physician, and the physician leadership. But it’s the involved physician who starts the conversation with the patient before Driver and his staff are brought in to assist when it comes to “making the patient whole,” which is the compensation piece.

“That’s reassuring for our physicians, because they’re involved in the conversation rather than somebody having the conversation and they’re not there,” Driver explains. “It enhances trust with the patient, and it enhances trust with the physician.”

And now their reputation precedes them. Driver says that within the local jurisdiction, attorneys know that, “If Stanford comes to you, and they offer to resolve the case, you’re better off resolving that case than taking it to trial. And that’s exactly how we want to be known.”

Copying Success

Driver says that for other healthcare entities wanting to go the same route, the first step is to check with their insurance carrier and risk management people.

“There’s a duty of cooperation.”

Then start slow, taking small steps at first. Find cases where it makes sense to get in early, disclose and compensate, and then learn. Once you gain experience, a more formal program can be adopted.

“Walk before you run,” Driver says. “And once you run, it just becomes the way you do business. And many medical malpractice carriers, at least in principle, support these programs.”