Ascension health's demonstration of full disclosure protocol for unexpected events during labor and delivery shows promise

• Published in: Health Affairs Vol. 33; no. 1; pp. 39 - 45
• Main Authors: Hendrich, Ann, McCoy, Christine Kocot, Gale, Jane, Sparkman, Lora, Santos, Palmira
• Format: Journal Article
• Language: English
• Published: United States The People to People Health Foundation, Inc., Project HOPE 01-01-2014
• Subjects: Acceptances; Case studies; Catholicism; Communication; Delivery, Obstetric - ethics; Delivery, Obstetric - legislation & jurisprudence; Disclosure; Disclosure - ethics; Disclosure - legislation & jurisprudence; Ethics, Medical; Family; Female; Health Care Reform - ethics; Health Care Reform - legislation & jurisprudence; Health Plan Implementation - ethics; Health Plan Implementation - legislation & jurisprudence; Hospitals; Hospitals, Religious - ethics; Hospitals, Religious - legislation & jurisprudence; Humans; Infant, Newborn; Insurance Claim Reporting - ethics; Insurance Claim Reporting - legislation & jurisprudence; Investigation; Labor; Leadership; Liability; Liability insurance; Managers; Medical Errors - ethics; Medical Errors - legislation & jurisprudence; Medical malpractice; Medical treatment; Nurses; Obstetric Labor Complications - diagnosis; Obstetrics; Organizations, Nonprofit - ethics; Organizations, Nonprofit - legislation & jurisprudence; Patients; Physician-Patient Relations - ethics; Physicians; Pregnancy; Quality Assurance, Health Care - ethics; Quality Assurance, Health Care - legislation & jurisprudence; Studies; Teams; Training; United States; United States; United States > US; Quality Of Care; Ethical Issues; Legal And Regulatory Issues; Physicians; Health Reform
• ISSN: 0278-2715; 1544-5208
• DOI: 10.1377/hlthaff.2013.1009

Communicating openly and honestly with patients and families about unexpected medical events-a policy known as full disclosure-improves outcomes for patients and providers. Although many certification and licensing organizations have declared full disclosure to be imperative, the adoption of and adherence to a full disclosure protocol is not common practice in most clinical settings. We conducted a case study of Ascension Health's implementation of a full disclosure protocol at five labor and delivery demonstration sites. Twenty-seven months after implementation, the rate of full disclosure had increased by 221 percent. Practitioners saw insurers' acceptance of the full disclosure protocol, consistent and ongoing leadership by local practitioners and hospitals, the establishment of a well-trained local investigation and disclosure team, and disclosure training for practitioners as key catalysts for change. Lessons learned from this multisite initiative can inform liability insurers and guide providers who are committed to ensuring that full disclosure becomes the only response to unexpected medical events.