Boothman was unaware of the Lexington story when the University of Michigan came to him for help in filling a staff job. He’d been a trial lawyer in private practice for 22 years, defending physicians and hospitals in malpractice suits. “Paradoxically, the better I got, the more likely I was to win a case I shouldn’t win, which ran counter to my clients’ long-term interests in quality and safety.”
Explore this issue:July 2015
He took the opportunity to share his thoughts about the medical malpractice system as a whole and about how the University of Michigan might change its process. “Michigan did not need a courtroom to know when the care was appropriate or not. I outlined for them, in essence, the Michigan Model,” he said. His first task was to circulate three interwoven principles: Patients harmed by unreasonable care should be made whole quickly and fairly; caregivers must be supported when care was reasonable; and the university must learn from its mistakes.
He found that the biggest resistance came from other lawyers. “This was not counterintuitive to physicians,” he said. “Almost across the board, the doctors and the healthcare leadership embraced this.” The university created a new position of chief risk officer, which reported to clinical leadership and not the general counsel.
Some lawyers benefit, he said. “By being honest, we help patients and we help their lawyers,” Boothman said. “Cases without merit are almost gone. The plaintiff’s bar understands the value of the approach.”
Do the Right Thing
“Patients trust us with their lives,” said Kevin Kavanagh, MD, MS, a retired otolaryngologist who now chairs the patient safety organization HealthWatch USA and is associate editor of the Journal of Patient Safety. He sees disclosure policies as a key tool in the prevention of adverse events. “It’s hard to have a culture of safety when you have a culture of denial and covering up errors. And disclosure is the ethical and moral thing to do.”
It’s the only way to have a quality assurance program that works, he added. “The errors I’ve been involved in, they’re often multiple levels of failure. A cascade of events, systems failures, more than one check that’s not working.” But by reporting and owning up to a mistake, physicians and their healthcare facilities can learn from it.
Dr. Kavanagh said disclosure policies should work equally well in smaller settings, such as a private practice. Although, given the fact that it is a culture change, it may take some practice—and support—to admit errors directly to patients. “I think we are hard-wired to perceive threats and to avoid them,” Boothman said, adding that the difficulty of admitting fault might be particularly acute in healthcare providers. “When things go badly, they take it personally and harder than most.”