Nearly one in two healthcare professionals will experience a 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 applies solely to the patient, but in certain cases, the information may be provided to the patient’s legal heirs or representatives (in the event of the patient’s death, if the patient is a minor, or if the patient is under guardianship, etc.).
The disclosure of harm associated with care is generally accompanied by a heavy 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 process of continuous improvement, it is essential to overcome certain barriers, such as a 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 that result in harm to a patient—whether “near misses” or incidents without physical consequences—should be reported.
Reporting harm associated with care is, above all, a patient-centered approach. Providing patients with transparent and comprehensive information is essential to improving 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.
After 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 determine what happened. This is the immediate debriefing, which helps to calm 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 for 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 provided guidance in its handbook, “Reporting an Adverse Event Related to Healthcare,” which helps to structure the reporting process and avoid common pitfalls:
- Introduction of the professionals in attendance,
- Acknowledgment 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 by suggesting follow-up appointments and providing guidance on potential legal options.
To help healthcare professionals disclose harm related to patient care, the SafeTeam Academy offers, in addition to these tips, the option to tailor your own approach. If you don’t have one, methods such as the SPIKES method are available and can also be used. What does SPIKES stand for?
- Setting: appropriate 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, bring it up right away 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 who are less comfortable with English will find the translated version, "EPICES," available in this article from the Swiss Medical Review.
These situations are always unique and can sometimes be complex; practicing them is essential.
And let’s not forget the human aspect of these announcements, particularly when it comes to the quality of communication and consideration for the emotions of both patients and caregivers.
As Walter Baile and Robert Buckman, two authors of *Spikes*, wrote in the title of one of their letters: "Breaking Bad News: More Than Just Guidelines"*
The SafeTeam Academy and the Announcement of Healthcare-Associated Injuries
Patients affected by healthcare-associated harm 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 when faced with such emotionally charged situations, healthcare professionals sometimes feel helpless. The SafeTeam Academy, in its early stages, 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
