THE BUSINESS OF PRACTICE: TODAY’S PRACTICE


breaking its leg during anesthetic recovery. As we know, this is a potential complication of anesthesia that can occur without any veterinary error. A vet- erinary error is failure to complete a plan as in- tended or the use of a wrong plan to achieve a clinical result. Examples of a veterinary error would include administering the wrong medication or wrong dose to a patient. In addition to their sensitivity to the client and family’s experience of disappointment when there have been adverse outcomes in care, clinicians and healthcare organizations are deeply fearful of formal complaints and potential malpractice suits. As a result, simply telling clinicians that they “ought” to disclose an unanticipated outcome or error is inef- fective. Recognizing this, Breaking the Silence: Disclosing Medical Errors, was developed in con- junction with the American Veterinary Medical As- sociation Professional Liability Insurance Trust (AVMA PLIT) to enable veterinarians to identify, appreciate, and practice using a model and tech- niques that are essential in responding to clients constructively when there has been an adverse out- come due to error. The model recommended for disclosure discus- sions is the TEAM model:


● Truth, teamwork, transparency ● Empathy ● Apology and accountability ● Management through to resolution


2. Discussion: The Team Model Truth, Teamwork, Transparency


Truth The client is entitled to an accurate understanding of what happened and its consequences. The key to that understanding is the practice’s candid investi- gation to sort through factors until reaching the most probable explanation. Reluctance to accept responsibility unless 100% certain is setting a much higher standard of certainty than was used to rec- ommend and undertake the treatment in the first place and will likely seem very self-serving to the client.


Transparency


Trust is rebuilt most effectively when the client senses that nothing is being hidden from them. The practice willingly shares relevant information and elicits and answers clients’ questions without the client needing to do her own investigation and come up with the “right questions.”


Teamwork


The practice team must feel empowered to recognize and report problems that could potentially compro- mise patient safety so that the practice may take action to correct the problem. Team members are


most likely to feel that they can do this when the practice team has shared values, adopts a nonpuni- tive approach to errors, and a commitment to hon- esty with each other and with clients. The ultimate resolution of the harm with the client may involve a number of staff members working together to recog- nize, elicit, and then follow through on the steps needed to resolve the situations as well as possible with the client.


Empathy


Empathy involves the ability to share one’s appreci- ation for the client’s perspective, feelings, and expe- rience. When clients experience disappointing outcomes related to the health of their animal, they may express a range of emotions that require effec- tive and sensitive communication skills by the vet- erinarian and staff. When the disappointment is related to a medical error on the part of the practice, the emotions may be heightened particularly if the practice gives any suggestions that they are with- holding information or are insensitive to the client’s feelings and needs. Core skills such as reflective listening and empathy are critical in such discus- sions, for example, “I know you are angry and that is perfectly understandable.” The veterinarian must be willing to acknowledge


and act based on an appreciation of the conse- quences of the error to the patient and the client. Rationalization and minimization can undermine our ability and willingness to empathize with the full range of impacts. The veterinarian and prac- tice team must be willing to appreciate the impact that recognizing and reporting an error may have on the staff involved. Their fears, heartbreak, per- haps defensiveness, and concern for consequences for themselves are all normal and need to be ac- knowledged. Creating a nonpunitive approach to errors that focuses on understanding and address- ing latent vulnerabilities to error rather than pun- ishing individuals is a key to empathizing with staff.


Apology and Accountability


When error has caused harm, a sincere and com- plete apology is necessary for resolution.11 “I am so sorry for the error that we made that caused this to happen to Sandy.” Studies of apology reveal 4 crit- ical components:


● Acknowledging the error ● Explaining how it occurred ● Holding oneself accountable to prevent its recurrence


● Offering reparation for the harm the other has experienced


The client wants to know that some good will come from the harm for other animals treated by the practice through correcting the procedures that led to the error. In order to convince the client that this will happen, the practice (see T above) must


AAEP PROCEEDINGS  Vol. 60  2014 271


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