4. Apology

When an adverse event occurs, offering an apology can be one of the most difficult things for healthcare professionals to do. In this lesson, we explain why apology is important and offer tips on how to apologize effectively.

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Ontario’s Apology Legislation

For many years, the simple act of apologizing to a patient or family has held a certain amount of confusion for healthcare professionals in Canada—a concern that by saying sorry when an adverse event has occurred, they would be opening themselves up to accountability, or even to liability. However, this is not the case. Only the facts surrounding an adverse event—how it happened, what was done, and who did what—are considered when determining liability.

Eight provinces and territories in Canada, including Ontario, have apology legislation. In 2009, Ontario implemented an Apology Act. This legislation assures healthcare providers that an apology cannot be seen as an admission of liability, and cannot be used in court proceedings to prove or disprove liability.

How to Apologize

In general, an apology should be offered at every stage of the disclosure process. Both the Canadian Medical Protective Association (CMPA) and the Canadian Patient Safety Institute (CPSI) recommend following many of the same practices as you would with disclosure—the two go hand-in-hand (see here and here).

• An apology should be a sincere expression of regret, delivered in a respectful and caring manner.
• Apologize in a private and comfortable setting.
• Make sure you have enough time to listen and address any questions and concerns.
• Be clear about what you are apologizing for. When an event first occurs, it’s okay to say, “I’m so sorry this happened. We’re going to try and figure it out.”
• Continue to have similar conversations, with the appropriate people present, throughout the disclosure process.
• Be prepared for negative emotions and feedback. Your apology may not be accepted.
• Understand that apologizing is difficult to do, but necessary and worthwhile for the patient’s or family’s emotional healing, and for your own.

Get Help and Support

For most healthcare providers, adverse events take place rarely throughout their careers. And although they may have taken classes on how to handle disclosure and apology, they may feel unprepared when an actual situation arises. It’s important to find help and support when an adverse event occurs in order to understand what you’re required to do, and how best to do it.

Here are some ways to find help:

• Many healthcare organizations have an employee assistance program available to staff.
• Your regulatory college or professional association may have resources.
• Other organizations, such as CPSI provide evidence-based approaches and tactics for apologizing.

The Value of Apologizing

When an apology is done well, everyone involved benefits from it. Patients and families may feel that their trust in the healthcare provider, and in the organization, has been restored; that their dignity has been respected, along with their right to know.

In Apologies and Medical Error, Jennifer Robbennoit writes, “Apologies—statements that acknowledge an error and its consequences, take responsibility, and communicate regret for having caused harm—can decrease blame, decrease anger, increase trust, and improve relationships. Importantly, apologies also have the potential to decrease the risk of a medical malpractice lawsuit and can help settle claims by patients.”

Many healthcare providers find that although an apology was very difficult to make initially, being honest and caring about what happened actually helped to restore their sense of confidence and self-worth.