At YNHHS, the reasons for disclosure are CLEAR

It is one of the most difficult situations a healthcare professional can face: Patients experience an unexpected or unanticipated outcome due to a complication or medical error. Yale New Haven Health is committed to disclosure – a communication philosophy and process in which physicians speak with patients and families with transparency, honesty and compassion about the outcome.

Why do we use disclosure?

Disclosure is a communication and resolution tool that gives patients and families a clear understanding of what occurred, how it occurred and what will be done moving forward. It is the beginning of a recovery process for patients, families and care-team members. The disclosure process is consistent with Yale New Haven Health’s standards of professional behavior, including putting patients and families first, integrity and accountability. It can strengthen the relationship between patient, family, clinicians and the hospital. It is the right thing to do, even if it is not easy.

What is the disclosure process at YNHHS?

It is called CLEAR, an acronym from the phrase: Communication Leads to EArly Resolution.This process flips the historic physician/hospital behaviors of “deny and defend” to behaviors that are open, transparent and based in honest communication. The purpose is to help the patient and family on their path toward closure by learning the truth about what, how and why events occurred.

What are the key components of disclosure?

• What happened
• Why the event happened, to the best of our current understanding
• How we will prevent such events in the future

Is it OK to apologize?

Yes. In fact, it is always appropriate to apologize in communications with patients and families, even if a medical error is not at the root of the unanticipated outcome. It is never wrong to say, “I’m sorry for what you’ve experienced.”

Does an apology imply responsibility or guilt?

No. An apology is always the right thing to do. We often apologize to friends, acquaintances and even strangers to express compassion for events and experiences we were not involved in (a new diagnosis, death of a loved one, a significant unfortunate life event). Beginning and perhaps ending a disclosure conversation with a sincere apology is important and always right.

Who does the disclosure? Who leads it? Who is there from the team?

As a general rule, the patient’s attending physician leads the disclosure, as they have the strongest relationship with the patient and provide oversight for his or her care. Coaching for a successful disclosure communication is strongly advised and is available for those who will be leading the disclosure. Disclosure Coaches are physician peers who have undergone specific training, including simulation, for these communication processes and they focus their efforts on preparing the team for a successful disclosure. Other disclosure attendees may include the primary nurse, patient relations team representative and house staff member primarily involved in the patient’s care.

What do we do if care-team members are very upset by what has occurred?

To provide the best care for our patients and their families, we must also support our care teams. A variety of resources, including crisis management, the Employee Assistance Program and others can help care-team members after an unanticipated patient outcome.

To initiate a disclosure at Yale New Haven Hospital, call 203-688-2291.

For more information about the CLEAR program, contact Alan Friedman, MD, YNHH director of Medical Affairs, [email protected].