Appendix C:
Respectful Management of Serious Clinical Adverse Events:
Disclosure Culture Assessment Tool
Element** Y Y/N N
Internal The organization, board, and leadership are grounded in the core values
Culture of of compassion and respect, and the responsibility to always tell the truth.
Safety Harm is seen as the failure of systems and not people, and is considered
in a fair and just culture with policies and practices.
Malpractice There is a commitment to rapid disclosure, compensation, and support.
Carrier There is a written understanding of how cases will be managed with carrier.
Mechanisms are in place for rapid, respectful resolution.
Policies, There is a policy on patient and family compassionate communications.
Guidelines, Informed consent policies and practices are up-to-date and effective.
Procedures,
Practices There is a policy on patient and family partnerships.
There are policies on disclosure and documentation.
There are procedures in place for internal and external communication.
Guidelines/policies support a fair and just culture, and reporting of
adverse events.
Root cause analyses commence immediately, are closely managed with an
executive sponsor. Results are shared, including with the patient/family.
There is a written crisis management plan. This plan is centrally located.
Policies/guidelines exist for reimbursement of out-of-pocket expenses.
Training Training programs are in place for all staff on communication,
expectations, policies, procedures, guidelines.
There is just-in-time coaching (training) for disclosures.
Disclosure There is rapid notification of patient/family and activation of support—
Processes typically, the organization shares what is known about the event.
There is a team to support staff in preparing for disclosure.
The The organization is transparent and honest.
Disclosure Responsibility is taken.
We are empathetic, apologize and/or acknowledge.
There is a commitment to providing follow-up information.
The caregiver is supported throughout the process.
Ongoing support is provided for the patient and family.
(continued on next page)
© 2011 Institute for Healthcare Improvement
Source: Conway J, Federico F, Stewart K, Campbell M. Respectful Management of Serious Clinical Adverse Events (Second
Edition). IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement;
2011. (Available on www.IHI.org)
Appendix C. Respectful Management of Serious Clinical Adverse Events: Disclosure Culture Assessment Tool (continued)
Element** Y Y/N N
Ongoing Resources are available to assist families experiencing unanticipated
Support outcomes—support is defined by the patient and family.
Resources are available to assist staff at the front line of unanticipated
outcomes—support is defined by needs of the clinician.
Procedures are in place and are known to ensure ongoing
communications with patients, families, and staff over months and
possibly years.
Resolution Procedures are in place and are known to bring the case to closure
respectfully, as viewed by the patient and family.
Learning Mechanisms are in place to ensure learning by the board, executive
leadership, Medical Staff Executive Committee, and across the
organization.
Measurement systems are in place to assess the impact of
communication, disclosure, and support on premiums, claims, cases,
and payments.
**Adapted from Medically Induced Trauma Support Services (MITSS)
For more information, the Institute for Healthcare Improvement Disclosure Toolkit and
Disclosure Culture Assessment Tool is available at: http://www.ihi.org/knowledge/Pages/Tools/
DisclosureToolkitandDisclosureCultureAssessmentTool.aspx.
© 2011 Institute for Healthcare Improvement
Source: Conway J, Federico F, Stewart K, Campbell M. Respectful Management of Serious Clinical Adverse Events (Second
Edition). IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement;
2011. (Available on www.IHI.org)
