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Restorative Circles in Hospitals: Reaching Closure When Things Go Wrong for Patients Melinda Zipin, MBA IIRP Conference, Toronto, Oct 22-24 2008.

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Restorative Circles in Hospitals:Reaching Closure When Things Go Wrong for PatientsMelinda Zipin, MBAIIRP Conference, Toronto, Oct 22-24 2008

Copyright 2008 Melinda Zipin; to be used only in total.Melinda@assertivediplomacy.comSources: Hospital information: NYTimes online, May 18, 2008NVC based Restorative Circles: developed by Dominic Barter; email at: contact@restorativecircles.org


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When things go wrong (in the US)

  • Baby James Mannix

    • 11 days old

    • Several clinical errors based on review of medical record


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Unwanted clinical outcomes: What happens?

Lawyers, insurers: “Deny and defend”

Patients & families: No info, no accountability, no voice, no healing

Clinicians: System breeds callousness

Malpractice suit a life-changing event for all


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Pioneer US Hospitals

  • U Michigan

  • Johns Hopkins

  • Stanford

  • U Illinois

  • Some VA hospitals


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Disclose, apologize,compensate – Why?

  • Restore integrity

  • Avoid future errors: Learn

  • Reduce patients’ anger, foster healing

  • Accountability and healing for clinicians


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Were the lawyers right?

  • U Michigan - lawsuits and legal defense costs down by 2/3

  • U Illinois - lawsuits down 50%

    37 apologies -> 1 patient lawsuit


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Why do patients sue?

  • Anger at concealment and “blank wall”

  • Concern it will happen again


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What do patients want?

  • To understand what happened

  • To speak and be heard

  • From “victim” to empowerment

  • Accountability from clinicians


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Restorative Circles & NonViolent Communication (NVC)

  • Patients sue in an attempt to meet basic human needs:

    • Understanding

    • To speak and be heard

    • Empathy, caring, support

    • Empowerment, agency

    • Accountability

    • Mourning

    • Peace

    • Financial sustenance

  • Which needs are met through lawsuits?


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What is an NVC-based Restorative Circle?

Facilitated meeting with dialogue

Safe supportive environment in which to hold conflict

Focus on hearing feelings and meeting needs

Toward: Both healing and action plan


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Some Principles

Each person gets to speak and be heard

Restore, reconnect, and meet needs

Voluntary; nonparticipation doesn’t stop circle

“No doctors, no lawyers, no patients – just people”


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Who participates?

Patient and family

Physicians, nurses

Others affected, others needed to resolve the conflict


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Pre-Circle

What happened?

Meaning for you?

“Here’s the process”

Consent


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In a Restorative Circle

  • “Where are you now?”

    • What did you hear?

    • Is that it?

  • “When you did that thing, what were you wanting?”

    • What did you hear?

    • Is that it?

  • “What next?”

    • What would you like to offer?

    • What would you like to request?


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Post-Circle

Do we like what happened?


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Who can benefit?(target market)

  • Patients and physicians who have endured malpractice suit

    • Seeking closure and healing

  • Patients and physicians

    • Proactively ASAP after things go wrong


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Who needs to buy in?

Risk management

CEO

Medical staff leadership


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Most likely hospitals

Self-insured

Most/all physicians are employees

University and VA hospitals


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Funding source

Malpractice defense fund


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Medical Errors in US

1% of hospital patients

About 98,000 die annually

Only 30% disclosed to patients

Only about 2% of patients file lawsuits


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In a world without blame

By disclosing and learning from errors, quality of care improves

Healing for patients and families; reasonable compensation

Accountability and healing for doctors


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For more information

Dominic Barter, developer of NVC based Restorative Circles, consultant Brazil Ministry of Justice –contact@restorativecircles.org

Melinda Zipin, bringing NVC based Restorative Circles to hospitals - melinda@assertivediplomacy.com

For emails, please use NVC Restorative Circles as Subject so your email will make it past spam filters.