Reed - Healthcare Resolutions Specialist - Walter Reed Army Medical Center

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Reed - Healthcare Resolutions Specialist - Walter Reed Army Medical Center Powered By Docstoc
					                                Healthcare Resolutions Specialist
The Healthcare Resolutions Specialist’s role is to promote respectful management of clinical adverse
or unanticipated healthcare events. Military Medicine benchmarks an intervention model which
aims to repair relationships, explore non-monetary resolutions, jointly discovering information which
will improve patient safety while concurrently delivering world class healthcare

Point of Contact: Ms. Judy Logeman, Walter Reed Army Medical Center 202-356-1012 ext 21055

Group involved with the best practice: Command initiative that impacts all direct and indirect patient
care providers and Military Health System beneficiaries.

Objective: The role of the Healthcare Resolutions Specialist (HRS) is to intervene when unanticipated or
adverse clinical events occur to objectively facilitate transparent communication between the
organization, healthcare providers, and the patient/family in a non-adversarial posture with the
intended outcome of equitable resolution for all parties involved. The HRS role is critical in ensuring
consistent, open, factual and compassionate communication with the patient/family. Concurrently, this
role supports the clinical staff in disclosure of the event with “just in time” coaching of listening,
reflective skills and documentation requirements. The HRS is pivotal in the institution's recognition of
the need to address and support the devastation, internal conflict, and emotional agony experienced by
all staff involved in adverse events. The ultimate goals of HSR's proactive overtures are to promote
emotional healing from adverse events for patient/family and staff, support organizational
accountability, learning, and culture of patient safety with open identification of process improvements,
and to restore trust in military healthcare.

Background: Medical errors are a challenging and unfortunate element in the complex world of
healthcare delivery. Historically, due to the ingrained medical training of “first, do no harm” and the
emphatic advice of the legal system for silence in a litigious culture, the standard response to adverse
events was to hide and deny. Fears of litigious reactions prohibit freely disclosing information,
acknowledging regret, and offering emotional support. The culture is evolving to meet the public
demand for full disclosure of facts when unexpected outcomes of care occur. Ethically, disclosure is a
known “right thing to do.” Additionally, medical, dental, nursing and allied healthcare professional
societies, as well as accreditation agencies (The Joint Commission, July 2001), have developed disclosure
mandates. Military Medicine is transitioning from a culture of individual blame to one of open
examination, disclosure, and system based improvement in the delivery of quality healthcare which is
patient/family centric. The Healthcare Resolutions Specialist concept has been a grassroots movement
within the Navy Medical Department for several years. During the Base Realignment and Closure (BRAC)
integration work with National Naval Medical Center Bethesda (NNMC), Walter Reed Army Medical
Center (WRAMC) recognized the value of the HRS in resolving complex healthcare issues at the earliest
opportunity, outside a legal venue, and with equitable resolutions for patients, providers, and the
organization. In 2009, WRAMC hired a full-time HRS.

Case study: The HRS was invited by Gastroenterology service to intervene with a patient readmitted for
post-procedure complications. Readmission included an ICU stay, fear and high anxiety, an attempt for
hospital transfer via AMA status, a request for information for legal avenues, and an adamant demeanor
against military healthcare. Intervention with physician and nursing staff averted the AMA transfer.
Subsequently, at the time the patient required a related additional procedure, all staff worked to offer
services at NNMC during which time the patient stated that the HRS was a “diffuser” and “we really do
not want to go the legal route, we just don't want this to happen to another patient." After the HRS
intervention, restoration of patient's trust in military medicine was demonstrated by her scheduling a
Neurosurgical procedure within the system.
Case study: Provider Support: Clinicians and allied health support staff suffer an emotional impact when
adverse medical events cause harm to patients. Institutions benefit when they provide a therapeutic
venue for discussion, debriefing, and gaining understanding of the systemic contributions to an event.
After a tragic, unexpected post-op death of an active duty soldier and post autopsy disclosure to family,
the HRS was invited to coordinate an open session for all staff involved in the care of this soldier - from
bedside clinical, to anesthesia, to surgeons, to pharmacy - a multidisciplinary and multi-level staff
disclosure session. Chaired by the Deputy Commander for Clinical Services, supported with an esteemed
Behavioral Health provider, all disciplines were encouraged to participate in an analysis of the event,
relating the impact on their professional performance in conjunction with searching for the underlying
system failures focusing on building reparative and improvement processes. Additionally, this provided a
venue to inform staff of the well-being and forward progress made by the family of the soldier, allowing
closure and emotional healing for the staff. This debriefing negates former perceptions that disclosure
unfairly targets physicians as sole source of what is often an institutional/systems cascade of impacting
Implementation methods: In order to implement an HRS service MHS-wide, there must be a formalized
program established at the DoD level with policies to outline role, relationships, responsibilities, and
functions. The program must have both an educational element and be actively marketed so all staff
have access immediately following an adverse event. Subsequently, additional HRS personnel will be
required with selection focusing on experience in both the healthcare arena and as a leader. The costs
associated with an HRS include the annual salary, facility requirements of a comfortable
office/conference area with seating for patient/family members to meet with providers, enabling open
communication in a private setting. As the program is formalized and expanded across the DoD,
quantifiable outcome based parameters can be established, for example, patient/provider satisfaction,
increased documentation of disclosure events, number of litigation claims filed, and number of referrals
to network.
Results: According to the cases cited above, it is possible to openly disclose medical errors and
concurrently restore trust in the military healthcare system and improve the quality of healthcare with
an open analysis from a multidisciplinary approach. Interdisciplinary barriers in the provision of
healthcare can be removed when individual interpretations of a medical error are openly shared.
Involvement of the HRS ensures that everyone has an advocate and that adverse events result in trust
instead of blame.
Conclusion: Case by case, the HRS earns the trust of patients, providers, and the organization. It is
important to remember that the patient is not the only victim; staff members are required to continue
providing world-class care for Soldiers, retirees and dependents. By creating a situation in which
providers and patients feel supported by the system of care, rather than stifled by rules and fear,
hospitals can promote emotional healing for all parties involved. The MHS would benefit from a HRS
program because it improves quality of care over time and promotes patient and provider satisfaction in
an open, nurturing environment.

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