Case Study: Healthcare

Lee Taft is a pioneer in the disclosure movement, a movement that began 10 years ago when the Joint Commission issued a regulatory requirement that patients be “informed about the outcomes of care, treatment, and services, including unanticipated outcomes.” The communication in which a patient is informed of an unanticipated outcome is called a disclosure. Disclosure includes communicating adverse outcomes – even those that are preventable.

The Stanford hospitals’ leadership team wanted to create a state-of-the-art disclosure process and asked Lee to help design and implement a model suitable for Stanford’s unique patient and provider population. The collaboration resulted in an innovative process that integrates disclosure with an early offer program. The Stanford process is known by the acronym PEARL: Process for the Early Assessment and Resolution of Loss.

Step 1 in the PEARL process is a factual assessment of what happened. There is no assumption that the unanticipated outcome experienced by the patient was preventable.

Step 2 is a conversation with the patient sharing what is factually known at that time. PEARL reminds providers that disclosure is often a serial conversation rather than a one-time event. If the unanticipated outcome was adverse and preventable, Stanford’s providers offer a fault-admitting apology for the outcome and the PEARL team works to arrive at a fair accommodation with the patient.

Step 3 in the PEARL process is to uncover why the event occurred so that lessons can be learned.  Implementing lessons learned ensures that other similarly situated patients will not experience similar adverse outcomes.

Stanford’s data reveals that over a 42-month period, claim frequency dropped by 36% compared to the preceding 24 months. Stanford is also achieving savings of $3.2 million per fiscal year since the inception of PEARL. Even more importantly, the integrity of the process promotes wellness for both patients and providers. Knowing that lessons have been learned and that others will not be similarly harmed transforms suffering and accountability invites forgiveness; accounting for harm caused also breaks the deadly cycle of addiction, burnout, and suicide studies report providers experience in the wake of medical mistake.