Emotional harm from disrespect: the neglected preventable harm.

To cite: Sokol-Hessner L, Folcarelli PH, Sands KEF. BMJ Qual Saf 2015;24:550–553. INTRODUCTION Consider these actual patient experiences: ▸ A patient is admitted to the hospital for a bowel obstruction from a known malignancy. She calls her cancer specialist about this complication, but he is unavailable. A covering provider reading from her file says ‘your cancer is untreatable’. This is the first time she has heard this. ▸ A patient dies in the hospital and the next day the funeral home collects a body from the hospital morgue. After embalming the body, the funeral home is notified by the hospital that they were given the wrong body. Because of this error, it may not be possible to process the correct body in time for the wake the following day. Despite being simultaneously dreadful and familiar to healthcare professionals, cases like these are not systematically identified or addressed in hospital quality improvement programmes. As a result, we have no good way of preventing them and patients inevitably continue to suffer from these unnecessary emotional harms. These cases are examples of preventable harm that are deserving of formal capture, classification and action by the healthcare system. The 1999 Institute of Medicine (IOM) Report To Err is Human found that existing definitions and systems for preventing harm were inadequate and recommended urgent, decisive steps to raise ‘standards and expectations for improvements in safety’. Since then our ability to define, measure and prevent patient harm has improved substantially. For instance, in 1999, central line-associated bloodstream infections were considered unfortunate, but expected complications. Today they are commonly prevented, saving many lives. To date, the patient safety movement has focused primarily on physical injury, but definitions of harm in healthcare are much broader: any ‘outcome that negatively affects the patient’s health and/or quality of life’. When asked about consequences of adverse events, patients emphasise emotional harm more than physical harm. Emotional harms can erode trust, leave patients feeling violated and damage patient–provider relationships. 9 Such injuries can be severe and long lasting, with adverse effects on physical health. Failures to acknowledge and systematically address these harms ensure that they continue. For these emotional harms, we are where we were with patient safety before 1999: we know they occur, but lacking a systematic approach to capture, categorise or assess them, we struggle to understand root causes and prevent future events. We do not even have reliable estimates of how often such harms occur. Some evidence suggests they may be more prevalent than physical harms. 11 Undoubtedly, some of these events are preventable. The costs of failing to prevent them—both financial and otherwise—are unjustifiable. As the IOM Report states, ‘it is simply not acceptable for patients to be harmed by the same health care system that is supposed to offer healing and comfort’. To focus our institution on these harms, we convened a multidisciplinary group which met regularly over the course of a year. The group included representation from healthcare quality, patient safety, risk management, performance assessment and regulatory compliance, ethics, social work, palliative care, communications, interpreter services, community relations, patient relations, hospital governance and our Patient Family Advisory Council. In this article, we describe how we have conceptualised these harms within the existing preventable harm framework, and we outline areas of future work.