Lexie Darch

Lexie Darch

“Sometimes we forget when people are sick or hurt that what they most need is to feel connected.”  That phrase by Lissa Rankin, M.D. popped up when I searched for Caring Conversations.


Insurance and Caring Conversations

In the realm of insurance claims, the industry has worked to foster a reputation of fairness and respect.  But communicating compassionately with patients and families who have experienced an unanticipated healthcare outcome has always presented a challenge to the insurance professional.  Why? Because the investigative process involves searching for answers and those answers are found most often in conversations with the practitioner, not with the patient.


Communication – A Key Component of Caring Conversations

We know also much of caring is about communication – how it’s received and perceived.  Are the words we’re saying really expressing what we mean?  Are they being heard and interpreted as we intend?  Are we saying too much?  Too little?  How much is enough?


Context is important.  I read an article recently about a seemingly innovative program designed to incentivize efficient, timely hospital discharges.  The concept included rewarding nurses on the unit who recorded the largest number of timely discharges by giving them a gift card. The INTENT of the program was not to kick patients out of the unit so that the bed could be turned over to another paying patient, but I suspect it could be perceived that way by the general public, many of whom already have a skewed view of healthcare.


Content is important as well, but I was particularly intrigued by a study undertaken by Dr. Albert Wu which revealed that the patient’s perception of what was said was more important than what actually was said.


At The Risk Authority, we pride ourselves in being innovative, and we are committed to patient satisfaction.  We also interact with patients when they are most vulnerable through our communication-and-resolution program known as PEARL.  So we pioneered a program that we call Caring Conversations, which is designed to help the healthcare professional handle those difficult communications with patients.


Through research and simulation our initial goal was to learn whether certain words evoked positive responses, and if so, whether it was possible to teach that methodology to the healthcare professional.  It seemed so logical; so simple; so obvious.


What we learned:


While the words themselves are important, the human interaction and development of a foundation of trust are even more so. It’s about making that connection with the individual.


How the words were delivered was a key factor in the evoked response from the patient and family.  Certainly, there were certain phrases that, no matter how they were delivered, resulted in negative, sometimes visceral responses.  But, importantly, we learned that listening – and really hearing – what the patient was saying, was the key.


We also learned through discussion with the observers following the exercise, that there was no universal agreement about how much information was “enough.”  It was an individual matter and may have had more to do with cultural and educational background.


A Dutch survey of patients’ experience revealed that 45% of patients felt that acknowledgment of the error was more important to them than compensation for damages.


In conducting the discussions with patients and families who had experienced an adverse outcome, we found that there were two overriding themes.  The patient wanted to know that actions are being taken to prevent the incident from happening again.  Over and over again, the importance of transparency and complete disclosure were mentioned as an avenue for building a trusting relationship.


For that reason, I was fascinated in an article that asked whether patients REALLY want to know when errors are made.  Do they really want to know everything?  One study found that 24% of patients do not.   I certainly would want to know when errors occur.  How can an environment change for the better if there is no transparency and mistakes are just swept under the rug?


In The Other Side of Apology, Victor R. Cotton, MD, JD, takes the position that while there are reports pointing to decreased lawsuits in institutions with an apology and disclosure program, there was in fact no control group and no report of a standardized methodology, among other factors.  Given the variables in play, a causal relationship between apology programs and the decrease in lawsuits could not be established.


I return to some of the lessons learned in Caring Conversations:

                Cognitively be open to hearing the patient’s concerns and set a tone of collaboration.

                Technically use active listening skills and,

                Behaviorally, connect with and be empathetic to the patient.


In the end, transparency and doing the right thing trumps worrying about getting sued.  If a mistake is made, it needs to be fixed so that it doesn’t happen again.


That is good risk management: what’s good for the patient, the physician, the staff and the institution.


By: Lexie Darch

Lexie currently serves as Vice President of Claims and Litigation Operations for The Risk Authority, and Senior Director of Claims and Litigation Operations for Stanford University Medical Center. She has over 30 years of experience in consulting and claims management and has served in a variety of operational and strategic roles including chief claims and services officer, consultant, liability claims manager and claims investigator. At The Risk Authority, she is responsible for the day-to-day administration and general operations of the claims team together with their supervision, training and mentoring.