Disclosure, Apology, and an Offer

On April 18, 2012, the Massachusetts Medical Society and an alliance of healthcare organizations announced a major initiative to improve the medical liability system in that state. The Roadmap to Reform ) describes a new approach to improve patient safety, increase transparency, reduce litigation, and cut costs to the healthcare system. The Roadmap proposes a process of disclosure, apology, and offer (referred to as “DA&O”).

With a DA&O model, healthcare professionals, institutions, and their insurers disclose adverse outcomes to patients and their families. They also investigate and determine what happened, establish systems to improve patient safety and prevent the recurrence of these incidents, and when appropriate, apologize and offer financial compensation. These proactive actions are intended to avoid patients resorting to legal action when adverse events occur. Patients may still pursue legal action, but legal action would become a “last resort.” Adverse events in which the provider or institution is deemed to have met the standard of care would be vigorously defended.

Seven hospitals in Massachusetts have agreed to participate in a pilot program that will implement these reforms in 2012. They include the Beth Israel Deaconess Medical Center in Boston, Beth Israel Deaconess Hospital-Needham, and Beth Israel Deaconess Hospital-Milton, Baystate Medical Center in Springfield, Baystate Franklin Medical Center in Greenfield, Baystate Mary Lane Hospital in Ware, and Massachusetts General Hospital. Implementation of the roadmap in Massachusetts is being supported in part by grants from the state’s three largest health insurers: Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care, and Tufts Associated Health Plan, along with the Reliant Medical Group.