The health implications of apologizing after an adverse event.

Australia is working towards a National Open Disclosure Standard in which all adverse incidents are disclosed to patients in all health-care facilities in the country. Among the many good reasons for this approach, one that has not attracted attention is the possibility that disclosure of an adverse incident may moderate its impact on the recovery and general health of patients. In this article, we discuss this perspective with reference to relevant psychological and physiological literature. In the absence of existing research that pursues this specific hypothesis on disclosure and health effects, we called on the extensive evidence that analogous traumatic events can lead to a prolonged state of negative affect and hyperarousal that are deleterious to recovery and health. This state is called 'unforgiveness' by some psychologists. Research suggests that unforgiveness can be alleviated if people who feel aggrieved forgive those they blame for the harm. Forgiving is a complex process, but there is evidence that it is promoted by an apologetic response that incorporates expressions of responsibility, regret and intended action. With the exception of responsibility, these components are part of open disclosure as envisaged in the Standard. We conclude that there is preliminary support from the psychological and physiological literature for further investigation of the hypothesis that disclosure can moderate the recovery and health of patients after an adverse incident, provided that the disclosure incorporates an admission of responsibility.

Apologies following an adverse medical event: The importance of focusing on the consumer's needs.

OBJECTIVE: The lack of a theoretical framework limits educators' ability to train health practitioners how to disclose, and apologise for adverse medical events. The multidimensional theory of apology proposes apologies consist of one or more components which can either be self-focused (focused on the apologiser's needs) or other-focused (focused on the needs of the consumer). We investigated whether the inclusion of other-focused elements in an apology enhanced its impact in a health setting. METHODS: 251 participants responded to a video-recording of an actor portraying a surgeon apologising to a patient for an adverse event. In one condition the apology was exclusively self-focused and in the other it was both self and other-focused. RESULTS: The self-focused apology was viewed more positively than negatively, but the apology that included additional other-focused elements elicited a more favourable reaction; it was seen as more sincere and as denoting more sorriness. CONCLUSION AND PRACTICE IMPLICATIONS: Practitioners can enhance the impact of their apologies by including other-focused elements, that is, demonstrate they understand the impact the event had on the consumers, express remorse for causing harm, and offer, or take action, to address the intangible harm caused.