Using simulation and coaching as a catalyst for introducing team-based medical error disclosure

Practitioners face many barriers to disclosing errors to patients, including embarrassment, fear of litigation, and minimal training in how to discuss them. Efforts at teaching error disclosure skills often focus on a one-on-one doctor-patient interaction and neglect the inter-professional context. This chapter describes research conducted at the University of Washington to assess whether participating in a team-based disclosure simulation training improved clinicians’ knowledge, attitudes, and skills regarding team-based disclosure of harmful errors to patients and team communication about avoiding such errors in the future. We developed two surgical and two medical error case scenarios based on real incidents. The premise of the simulations was that the members of a surgical or medical team had recently been involved in a harmful error and therefore needed to meet to discuss the event and how it happened, plan whether and how to disclose the event to the patient, and then perform the disclosure to the patient according to their plan. The nurses and physicians who participated in the simulations were experienced professionals. We trained actors from a professional troupe to perform the roles of a standardized team member and a standardized patient who had experienced a harmful error. We trained professionals from the fields of risk management and officers in patient or medication safety to become disclosure coaches who helped teams to discuss harmful errors and to plan whether and how to disclose errors to patients. Participants included 38 teams of physicians and nurses and risk managers from five different healthcare organizations in the Seattle area. Findings indicate that physicians developed an appreciation for team error disclosure. Nurses gained experience in participating as partners in conversations from which they had traditionally been excluded. Risk managers learned to participate in disclosure planning as educators, focusing on helping teams to rehearse and prepare for difficult conversations rather than dictating institutional regulations. These project outcomes are potentially transformative for the individuals and institutions involved.