Debriefing can turn lawsuit into opportunity
January 1, 1996 5 minutes read
Debriefing can turn lawsuit into opportunity
Before dust settles, take steps to reduce future risk
When your hospital has been involved in a lawsuit, turn the situation into an opportunity for positive change by conducting a debriefing, risk management experts advise.
The benefits of a debriefing can include immediate performance improvement, closure and confidence building, and reduced future risk, says Anna Blair, MBA, JD, general counsel and director of quality management at Helen Keller Hospital in Sheffield, AL.
"These bad things that can happen propel us into thinking and being aware," Blair says. She has found that debriefing the parties involved in a lawsuit reaps important benefits for the risk manager, the hospital, its physicians, and staff.
After a trial-court decision or settlement has resolved a lawsuit, Blair holds an informal meeting with the hospital staff who were involved, to report the outcomes of the case, to review changes that the involved departments have implemented to prevent further incidents, and to allow the participants to vent their feelings about the suit.
To date, Blair has conducted lawsuit debrief-ings only for cases in which the plaintiff has named the hospital as a party. She is also responsible for risk managing the hospital's affiliated physician practice, and she anticipates she will need to conduct debriefings for physician lawsuits. She does not foresee a need to modify the debriefing procedures for the physician practice.
As director of risk management for Promina Northwest Health System, Sam Bishop, ARM, CHPA, developed a similar debriefing process. The health system, based in Marietta, GA, includes five hospitals and 120 physicians in affiliated practices.
Blair and Bishop say conducting lawsuit debriefing sessions provides the following three benefits:
* Immediate performance improvement.
Although the actual lawsuit debriefing does not occur until the suit is resolved -- often as long as two years after the precipitating incident --- risk managers agree the seeds of the debriefing process should be sown immediately after the initial incident occurs.
Risk management, quality assurance ties
This works well when risk management and quality assurance have formal ties, Blair says. In addition to her duties as general counsel, for example, Blair is responsible for risk management, quality assurance, utilization review, and infection control. This puts her in an excellent position to integrate risk management with quality assurance.
After an incident occurs, Blair pursues the investigation through normal quality assurance channels and initiates performance improvement plans.
Bishop agrees the debriefing process should begin well before a case is resolved. He notes that in states such as Georgia, performance improvement plans initiated after an incident are not admissible as evidence in court. Therefore, Bishop advises risk managers not to wait until the case is resolved to start the ball rolling.
"This is particularly true if, during the course of the investigation, you find an issue of sub-par skills," Bishop says. "As a risk manager, you've got to step up to the table and fix that immed-iately. Use the initial investigation to fix as much as you can."
* Closure and confidence building.
Living with a lawsuit puts a strain on the involved people and can hamper their performance, says Bishop. A lawsuit debriefing brings closure to a long and difficult process and allows the affected individuals to regain their confidence.
"As soon as [the lawsuit] has been resolved, you owe it to your employees to get back to them," Bishop advises. "And you owe it to the institution you're serving to let managers know why decisions have been made."
For example, a lawsuit debriefing is especially important when the hospital agrees to a settlement, despite the wishes of a particular employee or manager, Bishop says. It is the role of the risk manager to explain to the employee why the hospital chose to settle.
Take care to make these discussions confidence building, not punitive, Bishop cautions. "After all, that same nurse or same professional is out there serving the patients every day."
Taking it personally
Blair agrees that lawsuit debriefing provides an emotional catharsis for the people involved.
"Even I take it personally," Blair says. "There are emotional aspects to being sued. The lawsuit debriefing provides an outlet to get rid of anger, resentment, rejection, guilt, whatever emotions people are feeling. I think this is just as important as the changing of processes."
Besides a standard debriefing held at the hospital, Bishop organizes a social outing for all the people involved, regardless of the outcome of the lawsuit. He invites the hospital's defense counsel to these outings to explain the legal processes that led up to the outcome of the case.
"For the first time, all of the involved parties get to talk openly about it in a relaxed atmosphere. We've found that really goes a long way in relieving tensions," says Bishop.
* Educating staff to reduce future risk.
A lawsuit debriefing is the perfect forum for educating employees about risk management issues, Blair and Bishop agree.
As a follow-up to the lawsuit debriefing, Bishop asks nurses who have been involved in the lawsuit to conduct inservices for their peers. Because documentation is a key issue in many lawsuits, these inservices usually focus on correct documentation procedures and the impact of legal issues on nursing practice.
Nurses absorb this type of information better when it comes from peers who have actually experienced a lawsuit, Bishop maintains.
As a former hospital educator, Blair also stresses the importance of education in the debriefing process.
"Lawyer means teacher, as one of my favorite law school professors said in one of his first lectures," says Blair. "A debriefing is a way of teaching. You learn from your mistakes, if indeed you made any."
Blair cites a lawsuit brought against the hospital by a plaintiff who alleged he slipped on a piece of ice in the cafeteria. After the hospital agreed to a settlement, Blair met with both shifts of cafeteria staff to discuss the incident and changes in the department to prevent similar occurrences. In addition to a new cafeteria layout and improved safety checks, Blair instituted new employee orientation, which she conducts.
She describes her method of teaching risk management issues in a down-to-earth manner: "I put a piece of ice in a Styrofoam cup and pass it around. Then I ask the staff how much they would bid me for this piece of ice. How much is it worth? I get a lot of blank stares," laughs Blair. "Then I tell them this piece of ice is worth $54,000" -- the amount of the settlement.
(For guidelines for conducting a debriefing, see related story, p. 4.) *
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