Disclosure Programs: The Michigan Model

Every year a number of doctors and other health care professionals make mistakes when treating patients. However, doctors don’t like to talk about the errors that they have made because of the fear of being sued for medical malpractice. And though this is something that doctors must be aware of, talking to patients about errors that the doctor committed can be beneficial. In fact, one study found that “‘full disclosure after a medical error reduces the likelihood that patients will change physicians, improves patient satisfaction, increases trust in the physician, and results in a more positive emotional response.'”

The traditional approach used by the health care community when an error has been committed by doctors or other members of the medical staff is to “deny and defend”. However, this approach discourages any communication between the doctor and the patient. A patient or family member of a patient who wants to know what went wrong is unable to get the answers they need because the doctor or health care institution is afraid of admitting anything that could lead to legal liability. A 2010 New York Times article demonstrates this “deny and defend” mentality. A doctor had a patient died under her care. The doctor was grieving and wanted to attend the patient’s funeral but the hospital’s risk management administrators wouldn’t let her because there were rumors the patient’s family might sue the hospital. In addition, risk management had told hospital staff members not to discuss the case with anyone.

However, attitudes are changing and there have been movements towards transparency. One of the first programs that promoted communication about errors as well as disclosure of what happened to patients was set up at the University of Michigan Health System (UMHS) in Ann Arbor. Now termed, the “Michigan Model”, this “disclosure and offer” program was started in 2001. According to the Times, the program facilitates a series of meetings between patients and family members and the various members of the hospital staff including “doctors, other involved clinicians and members of the hospital’s risk management department.”At the meeting the hospital offers “assurances that the investigation will be timely and thorough, and promise[s] that all will be done to prevent to prevent such a mistake from ever occurring again.” If an error is found then compensation is offered. The form of compensation varies and can range from a “simple formal apology to a check, mortgage payments and funding for named lectureships and memorials.”

If UMHS determines that no error has been committed on behalf of the hospital, then the hospital defends its staff and usually refuses to settle, even if that means going to court. Though settling with patients may be less expensive, “the UMHS views court cases in which they defend reasonable care as an investment in the integrity of their institution and the D&O program, and as an important demonstration of UMHS’ commitment to safe, high-quality care.”

The disclosure and offer program has largely been considered a success. A study that evaluated the program “found that there were fewer lawsuits and claims after the hospital began its disclosure with compensation program.” In addition, they found “the hospital system’s liability costs for lawsuits, patient compensation and legal fees dropped, and claims in general were resolved faster than ever before.”

However, there is competing data about whether or not these programs are effective in deterring lawsuits. The Washington Post stated that one study in Health Affairs “found that error disclosure, resolution and compensation did not necessarily decrease the likelihood that a patient would pursue legal advice.”

A similar program to the Michigan Model has been implemented at Stanford Hospital.