'Sorry' response cuts malpractice claims, legal costs

A disclosure, apology and offer program at the University of Michigan Health System is "more promising than any other liability reform option," according to researchers of the decade-long approach.

The "Michigan Model" examines the care provided, involving patients and their families, according to a December study in Milbank Quarterly.

Study authors from Harvard Medical School and the Massachusetts Medical Society found that a culture of transparency and apology reduces legal costs, cuts malpractice suits and speeds up closing times for claims. They concluded that the Michigan Model could--and should--be implemented nationwide.

"By handling unanticipated and unintended incidents and patient injuries, honestly and proactively, we've virtually eliminated groundless legal claims, allowing us to focus on issues that demand attention with clear vision and no more excuses," Rick Boothman, executive director of clinical safety, said in a statement Thursday.

The health system has an institutional policy, which calls for open communication with patients and their representatives after a complaint. The hospital reviews the complaint impartially, including peer review. The health system offers to meet with the patient's legal counsel if he or she has representation. If during the review, the hospital determines that medical care was inappropriate, the hospital apologizes to reach a resolution, which may be a settlement. Even if the review determines that care was appropriate, the hospital still offers to meet with the patient to explain what happened.

"Many patients are satisfied with full explanations and may even drop their complaint or suit," according to the University of Michigan Health System website.

If the patient decides to sue, the health system defends its staff.

Although U of Michigan says the approach isn't perfect, the model, coupled with statewide reform, has proven to be successful.

Michigan has a six-month "cooling off" period, in which defendants must submit a notice of intent before going to court. The health system also self-insures in malpractice insurance.

Viewing the courtroom as the last resort, the health system's model has resulted in fewer malpractice claims, from 260 pre-suit claims and pending lawsuits in July 2001 to currently 100. The average legal expenses also fell 50 percent since 1997, and open-to-close time for claims dropped to 10 months from more than 20 months in 2001.

"(Disclosure, apology and offer) programs may prove not only to constrain liability costs but also to improve access to compensation, strengthen linkages between the liability system and patient safety, increase healthcare organizations' accountability and patient advocacy, and promote transparency in regard to medical error," study authors wrote.

For more information:
- see the research announcement
- check out the study abstract
- here's info on the Michigan Model  

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