Communication and Resolution: Lessons Learned From REACT

Even when patients receive appropriate care and everything is done correctly, an adverse event or complication can occur. Communication and Resolution Programs (CRPs) can assist healthcare professionals in responding to these events by emphasizing empathetic communication and timely resolution of unanticipated events that result in patient harm. CRPs can also improve the quality of care by fostering accountability and promoting shared learning among practitioners, which can prevent adverse events from happening again.
 
Launched in 2008, Coverys’ REACT® (Respond Effectively And Communicate Timely) is an early resolution program designed to assist participating policyholders and their patients after an adverse event has taken place. The REACT program offers assistance and resources to participating practitioners, helping them respond promptly and effectively to the needs of patients who have suffered harm.

By the time a practitioner contacts the REACT program for assistance, a disclosure conversation has typically taken place. However, the patient may require additional treatment or incur additional expenses resulting from the event. Even in situations involving a known complication or a long-standing practitioner-patient relationship, if patients face financial hardship after an adverse event, they may feel pressure to file a claim or suit. REACT may lessen the financial impact of qualifying adverse events by reimbursing some out-of-pocket expenses.
 

Lessons Learned from REACT

Over the last 15 years of working with the REACT program, I have interacted with thousands of practitioners and patients after adverse events to provide compassionate and timely resolutions. Through these interactions, I have learned several valuable lessons that can help practitioners improve communication and better meet their patients’ needs after an adverse event.

• Lesson #1: Encourage conversation. The best way to appreciate a patient’s experience is by asking them to tell you about it. Unfortunately, when patients initially contact REACT, they are often angry, skeptical, or hesitant to share information. Starting a conversation with an intentionally broad and open-ended question like “Can you tell me what happened?” encourages the patient to share what is meaningful to them. Once the patient is put at ease and able to share their experience, they are more willing to receive assistance.
• Lesson #2: Patients want to be heard and understood. While reviewing medical records following an adverse event is helpful in assessing the clinical situation, it does not allow me to understand the situation from the patient’s perspective. When discussing their experience with me, patients will often go into great detail about the event and their interactions with practitioners and staff. Sometimes they will describe how they felt during the encounter. By engaging in the conversation, actively listening, and expressing empathy, I let patients know that I understand what they experienced and how it has affected them.
• Lesson #3: Proactive communication after the event can make a difference. The period following an adverse event is a confusing time. Patients may be in pain, concerned about whether they will make a full recovery, or overwhelmed by the clinical information provided in the disclosure conversation. As a result, they may not fully comprehend the information that is disclosed.

Once the patient returns home, they may receive a barrage of advice from well-meaning friends and family. They may also receive bills for follow-up care. During this time, the patient may begin to question the medical care they received. When communication has been suboptimal, or personal follow-up from the practitioner has been nonexistent, the patient may feel that the practitioner lacks concern or is avoiding them. This can in turn lead to an erosion of trust and negative inferences about the quality of care. 

Sometimes patients will express gratitude for the care and compassion shown by their practitioners after an adverse event. Typically, these are instances when the practitioners did more than just disclose the event. Instead, they proactively reached out to the patient during the hospitalization and maintained contact after discharge to offer further disclosure and express concern. Timely, proactive expressions of empathy and compassion can make a difference for patients and their families. 

• Lesson #4: Respond promptly to complaints. If the patient lodges a complaint with the practitioner and/or practice, it is essential to respond promptly. Patients who are mildly annoyed may get angry if they feel their concerns are being ignored. If you are unsure about how to respond to a patient complaint, contact your organization’s risk management department.
• Lesson #5: Informed consent is important. In many cases, an adverse event is a known complication of a treatment or procedure. The informed consent discussion may have left the patient with a poor understanding of the risks associated with the treatment or procedure or with unrealistic expectations regarding the outcome or course of recovery. In other cases, the informed consent discussion may have been documented inadequately in the medical record, leaving the practitioner with no proof of what they shared with the patient. 

Regardless of the reason for the misunderstanding, good policies and procedures regarding informed consent can help avoid conflict and set appropriate expectations. Ensure your policies and procedures address key elements of informed consent and provide guidelines for informed consent documentation. 

• Lesson #6: Demonstrate honesty, respect, and empathy in every patient interaction. Patients are less inclined to file lawsuits and make claims against practitioners they genuinely like. While the REACT program can be helpful after an adverse event occurs, it cannot replace what practitioners do every day—delivering compassionate, patient-centered medical care. Strive to reflect these values in every patient interaction. 

While no patient is happy about a bad outcome or adverse event, good policies and procedures, empathetic and compassionate communication, and timely resolution can help reduce conflict and enhance the practitioner-patient relationship. 
 

REACT: A Value-Added Service for Coverys Policyholders

The REACT program is offered to Coverys policyholders, if eligible, at no extra cost. No additional premium or fees will be charged for enrolling in and/or taking part in the REACT program.