Question 11 pts
Reliance on the integrity, strength, ability, surety of a person or thing is the definition of
Honesty
Authority
Faith
Trust
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Question 21 pts
To make known, reveal or uncover is the definition of
Disclose
Unravel
Prevent
Secret
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Question 31 pts
A written or spoken expression of one’s regret, remorse or sorrow for having insulted, failed,
injured or wronged another is the definition of
Consequence
Repentance
Confession
Apology
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Question 41 pts
Healthcare as an industry has only recently embraced the concepts of high reliability.
True
False
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Question 51 pts
In high reliability organizations, the work that occurs after the error is as important as the
work spent focusing on preventing the error.
True
False
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Question 61 pts
Physicians agree that the information they disclose to a patient is fairly consistent from
physician to physician.
True
False
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Question 71 pts
Healthcare often looks to other high risk industries when modeling its safety plans but none
of these industries has a disclosure policy close to healthcare.
True
False
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Question 81 pts
Many physicians and healthcare providers agree with the principle of apologizing for errors,
and most practice this as well.
True
False
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Question 91 pts
Which state is mentioned in chapter 36 as having one of the most extensive disclosure and
apology laws of any state?
Utah
Minnesota
California
Colorado
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Question 101 pts
Studies have shown that incorporating disclosure and apology into risk management
programs and patient safety programs is ultimately good for the bottom line.
True
False
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Question 111 pts
Becoming a high reliability organization requires which of the following components?
Trust
Disclosure
Apologies
All of the above
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Question 121 pts
In the past, healthcare providers have allowed fear of the following to affect how they
provide service:
Litigation
Sanctions
Mistakes
Reputation
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Question 131 pts
Which of the following is at the center of the conflict between patients and their physicians?
Ego
Literacy
Communication
Regulation
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Question 141 pts
Which item puts the physicians most at risk of a lawsuit after a medical error has been
discovered?
Quality of care
Communication with patients
Chart documentation
Technical negligence
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Question 151 pts
Because of increased risk and increased medical malpractice premiums, many physicians see
each patient as a potential:
Enemy
Opportunity
Litigant
Problem
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Question 161 pts
What is the worst consequence following the discovery of a medical error?
Broken trust
Financial penalties
Damaged reputation
Time consuming litigation process
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Question 171 pts
What is an unexpected occurrence involving death or serious physiological or psychological
injury?
Medical error
Unanticipated event
Near miss
Sentinel event
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Question 181 pts
What can a physician/health care organization do to reduce the risk of litigation once an
error is discovered?
Disclose what happened
Retain an attourney
Don’t talk to anyone but the lawyer
Enlist the help of the marketing department to manage the patient’s anger
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Question 191 pts
In the event of an error that resulted in injuring the patient and the resonsible party (i.e.,
doctor) fails to take responsibility, which type of apology is preferred?
Full apology from the organization
Partial apology from the responsible party
No apology from the responsible party
Partial apology from the organization
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Question 201 pts
What is the purpose of Colorado’s “3Rs” program?
Report, revise, return
Recognize, respond, resolve
Prevent medical injuries from entering an ineffective, inefficient, and adversarial legal
system
Protect patients from medical errors
Chapter 36: Trust, Disclosure, Apology:
How we Act When Things Go Wrong Has
an Impact on Patient Safety
Keith Siddel, MBA, JD, PhD
Introduction
• Trust, disclosure, and apologies when
appropriate, are essential components of
achieving high reliability in health care
organizations
Introduction
• Key characteristics of high reliability
– Trust and transparency
– Reporting
– Flexibility in hierarchy
– Organizations perceived to be just and
accountable
– Engagement and dedication in continuous
learning
Trust
• Trust incorporates transparency,
accountability, and reporting
• Physician-patient and hospital-patient
relationship built into foundation of trust
• Healthcare providers at all levels must be
involved in process
Disclosure
• Disclosure incorporates transparency,
accountability, and reporting
• Sizable gap exists between patients’ desire to
be told about medical errors and the current
• Wide disparity between what various
organizations and providers believe should be
disclosed to patient
• Healthcare industry divided on position of
apologizing for “near misses”
Disclosure
• Practice of non-disclosure arose out of fear of
litigation and a desire to preserve an
organization’s reputation
• Legislative reforms focused on making it easier
for patients to get information about what
happened during their care
Disclosure
• Study reported following common reasons for
deciding to file malpractice case:
– Physicians would not listen (13%)
– Physicians would not talk openly (32%)
– Physicians attempted to misled them (48%)
– Physicians did not warn about long-term
problems (70%)
Disclosure
• Elements of a successful disclosure program
should be:
– Explanation
– Open investigation
– Involvement of the patient and in some cases
family
– Apology
– Compensation
– Acknowledgment of harm
Disclosure
• Study found that after full disclosure and an
apology, patients felt providers were more
trusted, satisfied, and less likely to change
physicians than when they received
incomplete and evasive explanations
Apology
• Three broad categories:
1. Those that are full, personal and sincere, and
accompanied by acknowledgment of
responsibility
2. Those that are impersonal or non-specific
3. Those that accept responsibility on behalf of
institution or third party
• If provider will not give an apology defined in
1, it is better to not give one as defined in 2
and 3
Apology
• Many physicians and healthcare providers would
agree with principle of apologizing for errors in
theory, but few actually practice it
• Fear of litigation was primary reason for both
physicians’ and hospitals’ reluctance to disclosure
errors, unanticipated outcomes, or to apologize
• Fault-admitting apologies under American law
are ordinarily admissible to prove liability,
although many states prevent this when they
occur during mediation or settlement
negotiations
Outcomes
• Study at University of Michigan found that
program which physicians report errors,
disclose error, and apologize to patient
resulted in costs from $3 million to $1 million
and reduced the time period in which cases
were resolved
• Studies involving hypothetical situations found
that apologies may reduce likelihood of
litigation
Outcomes
• Critics argue that disclosing error will place
provider in worse situation because majority
of patients in adverse medical event are
unaware of medical errors