Disclosure of Unanticipated Outcomes

June 17, 2022

Reading time: 4 minutes

Unanticipated outcomes¹ that occur in the healthcare system can cause physical and psychological
harm to patients, their families, and healthcare providers and staff. However, disclosure of
unanticipated outcomes — when properly performed — can lessen the negative consequences.

Addressing these outcomes with honesty and transparency is not only part of a well-defined disclosure
process, but also an integral step in providing patient-centered care. To prepare for the disclosure
process, healthcare organizations should develop clear policies/protocols and train their providers and
staff accordingly. This checklist can help healthcare organizations assess various aspects of their
disclosure policies and identify improvement opportunities.

Yes

Does your healthcare organization have a written disclosure policy that complies with state laws and professional guidance related to the disclosure process?

Does your healthcare organization support a culture of safety and transparency in which:
• Providers and staff are encouraged to report unanticipated outcomes?
• Unanticipated outcomes are viewed as learning opportunities?

Do healthcare providers and staff receive training on your healthcare organization’s disclosure policy and process?

Does your healthcare organization consider conducting role-playing or simulation exercises to offer healthcare providers and staff hands-on disclosure training?

Are healthcare providers and staff educated about the difference between an apology and an admission of liability?

Has your healthcare organization established a threshold for situations requiring disclosure?

Does your healthcare organization gather information about the unanticipated outcome from providers and staff who were involved and from a formal investigation of the event?

Do healthcare providers offer an empathetic acknowledgment to the patient/family as soon as possible after an unanticipated outcome?

Does your healthcare organization hold predisclosure preparation meetings for providers and staff members who will participate in the disclosure process?

Are disclosure meetings with patients/families scheduled as soon as practical following unanticipated outcomes?

Does your healthcare organization notify its professional liability carrier about disclosure meetings?

Does your healthcare organization determine in advance of a disclosure meeting who will participate on behalf of the organization and the patient?

Is an appropriate individual assigned to lead the disclosure meeting?

Is the disclosure meeting held in a private and secure area?

Is your healthcare organization’s risk management staff involved in the initial disclosure conversation and subsequent patient follow-up?

Do all healthcare employees involved agree on an agenda and the information that will be discussed before the disclosure meeting?

Does the disclosure meeting involve clearly communicating the facts as they are known at the time of the disclosure, including:
• The nature of the event?
• The time, place, and circumstances (if known)?
• The proximal cause, if known? (If unknown, it is okay to say so — don’t guess or assume.)
• The known consequences and actions that have been taken to address the consequences?
• The management of the patient’s ongoing care?
• The implications for short- and long-term progress?

Does the disclosure meeting involve explaining the plan of action relative to either continued investigation or process changes that might help prevent similar outcomes?

During the disclosure meeting, are the patient/family given an opportunity to ask questions and clarify information?

Are the patients/family provided with an organizational contact who will provide follow-up information as it becomes available?

Are additional counseling services offered to the patient/family, and are they given the names of agencies that they can contact to address their concerns or complaints?

Has the disclosure leader established a date and time for follow-up communication as more information becomes available based on developments from investigating the event, changes in the patient’s condition, or modifications to the treatment plan?

Does the disclosure leader or another appropriate team member document who attended the disclosure meeting and the content of the disclosure in the patient’s health record?

Are these specific items related to disclosure documented in the health record:
Time, date, and place that the conversation occurs?
The information that is communicated to the patient/family?
The patient’s/family’s understanding, any questions they ask or information they want clarified, and any responses provided to questions?
Names of those present for the disclosure conversation, and who is responsible for follow-up communication with the patient/family?
Next steps for patient treatment, care, and communication?
A notation that disclosure was based on information available at the time of the conversation with the patient/family?

Does your organization conduct a debriefing session with the disclosure team to determine support needs and to review the disclosure process?

Does your organization offer a second victim support program for healthcare providers and staff members who are involved in unanticipated outcomes?

Has your organization developed written policies and procedures for second victim support and resources, and have organizational leaders, providers, and staff been educated about them?

Does your organization’s second victim support program include rapid response provisions?

More Information

For more details on disclosure — including information about training for disclosure, the process of disclosure, disclosure documentation, and second victim support — see ChiroPreferred by MedPro’s guideline Disclosure of Unanticipated Outcomes and Risk Resources: Disclosure of Unanticipated Outcomes.

¹For the purposes of this publication, unanticipated outcomes refer to (a) outcomes of care that differ significantly from anticipated outcomes, (b) medical errors caused by deviations in the standard of care, and (c) patient harm that results from medical mismanagement or system failures.

Additional Risk Tips content

Financial Management Tips for Chiropractors

Risk Tips

Many chiropractors own their practice and must manage the practice’s finances. From investing in marketing to repaying a loan, financial…

Chiropractic Billing and Coding Tips

Risk Tips

Chiropractic billing and coding can be a complex and time-consuming task. However, it’s essential to ensure that you get paid…

Chiropractic Cash Practice Pros and Cons

Risk Tips

The chiropractic cash practice model is undoubtedly becoming more common. This article will unpack the pros and cons of a…

This document should not be construed as medical or legal advice and should not be construed as rules or establishing a standard of care. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your attorney or other professional advisors if you have any questions related to your legal or medical obligations or rights, state or federal laws, contract interpretation, or other legal questions.

MedPro Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company, PLICO, Inc. and MedPro RRG Risk Retention Group. All insurance products are underwritten and administered by these and other Berkshire Hathaway affiliates, including National Fire & Marine Insurance Company. Product availability is based upon business and/or regulatory approval and/or may differ among companies.