Nearly one in two healthcare professionals will be involved in a serious accident (serious adverse event) during their career. While prevention and recovery strategies exist and are generally well-known, mitigation strategies remain important and also deserve to be better understood.
Immediate team debriefing and informing patients and their families of the harm associated with care are fundamental elements of the harm mitigation strategy.
Whether from a moral, ethical, or legal standpoint, informing patients and their families of harm associated with care is part of a healthcare professional's duty. According to the Public Health Code*, “every person has the right to be informed about their state of health”.
In principle, this duty to inform is owed solely to the patient, but in certain cases, the information may be provided to their legal heirs or representatives (death of the patient, minor patient or patient under guardianship, etc.).
The announcement of harm associated with care is generally accompanied by a strong emotional burden. Informing a patient that they have been the victim of an accident or error during treatment can be a difficult moment for healthcare professionals. To meet patients' expectations and to integrate professional practices into a continuous improvement process, it is essential to overcome certain barriers such as lack of training, caregivers' difficulty in managing their emotions, or the fear of potential lawsuits. With the aim of reassuring and supporting healthcare professionals in this often difficult process, and also to meet the legitimate expectations and needs of patients, the French National Authority for Health (HAS) has published a guide on this subject, which we are sharing with you. An approach centered on the patient-caregiver team and on Improving the Safety of Care
According to the French National Authority for Health (HAS), an adverse event is defined as “an event or circumstance associated with care that could have caused or did cause harm to a patient and that we hope will not happen again.”*
All adverse events resulting in harm to a patient, whether “near misses” or incidents without physical consequences, should be reported.
Reporting harm associated with care is first and foremost a patient-centered approach. Providing patients with transparent and comprehensive information is fundamental to contributing to the improvement of the safety of care.
To rebuild and maintain this relationship during this difficult time, communication is key. However, this cannot be improvised and must be adapted.
Following an accident, one of the patients' expectations is to understand what happened and why the accident occurred. With this in mind, the healthcare team must meet immediately after the accident to understand what happened. This is the immediate debriefing, which will help to defuse emotions within the healthcare team and to review and understand the facts.
Once the immediate debriefing has taken place, it is necessary to prepare the announcement to the patients or their families.
This announcement requires non-technical skills that should be developed and highlighted.
The French National Authority for Health (HAS) has formulated some advice in its guide, “Announcing an Injury Associated with Care,” which helps to structure the announcement and avoid some pitfalls:
- Introduction of the professionals present,
- Acknowledgement of the injury,
- Description of the facts,
- Expression of Regret and apology,
- Consultation with the patient regarding continuity of care,
- Offering support options,
- Concluding the interview with a proposal for follow-up appointments and guidance on possible legal recourse.
To assist healthcare professionals in disclosing harm related to care, the SafeTeam Academy shares, in addition to these tips, the possibility of personalizing your own approach. If you don't have one, methods like the SPIKES method exist and can also be used. What does SPIKES mean?
- Setting: suitable location, key people present,
- Perception: ask the patient about their perception of the situation,
- Invitation: ask the patient how much information they want to know,
- Knowledge: present the medical facts; if the news is bad, present it upfront before going into the details,
- Emotions: be empathetic and reassuring,
- Support: explain the strategy and the next steps.
SPIKES is a "generic" guide for delivering bad news. Those less comfortable with English will find the translated version "EPICES" offered in this article from the Swiss Medical Review.
These situations are always unique and sometimes complex; practicing them is essential.
And let's remember the human dimension of these announcements, particularly in the quality of communication and the consideration of emotions, both those of patients and those of caregivers.
As Walter Baile and Robert Buckman, two authors of Spikes, said in the title of one of their letters: "Breaking Bad News: More Than Just Guidelines"*
The SafeTeam Academy and the Announcement of Healthcare-Associated Injury
Patients affected by healthcare-associated injury have many expectations. They want to know, understand, and be informed. However, supporting patients through these difficult times is not something that can be improvised, and faced with such emotionally charged situations, healthcare professionals sometimes feel helpless. The SafeTeam Academy, in its initial development, chose to address this topic and offer a module on disclosing harm related to care, enabling healthcare professionals to anticipate these situations. Through an immersive video, caregivers will be able to reflect on their practices regarding team debriefing after an incident and the disclosure of harm related to care. They then attend a debriefing session led by Anne Rocher, a clinical psychologist working in intensive care and a business executive coach, who is an expert on these issues. Like all SafeTeam Academy training programs, the goal is to stimulate learners' reflection on areas for improvement—individual, collective, and institutional. If you too would like to contribute to improving the reliability of care within your organization, SafeTeam Academy training is for you! For more information, write to the following address: contact@safeteam.academy
