June 15, 2009

Handling It Well When Things Go Bad
By John D. Halamka, MD, MS
Radiology Today
Vol. 10 No. 12 P. 5

Editor’s note: John D. Halamka, MD, MS, is an emergency physician and the chief information officer and dean for technology at Harvard Medical School. His blog, “Life as a Healthcare CIO,” can be viewed at http://geekdoctor.blogspot.com. This article was edited from a post on that blog.

As readers of my blog know, I’ve adopted many aspects of Japanese lifestyle into my household, including food, music, and clothing.

Learning to apologize is also something I’ve learned from the Japanese. You’ll find a great description in the Etiquette Guide to Japan by Boye De Mente.
A typical corporate apology in Japan is accompanied by a low bow, a sincere apology, and a possible resignation. Atoning for a mistake in the U.S. does not require the loss of your job (or anything more extreme).

When bad things happen, here is the approach I use:

1. Encourage openness and transparency in your staff. In other words, do not shoot the messenger. By empowering every person to communicate the events objectively, you’ll get to the root cause more rapidly.

2. Ask what can be done to improve the organization rather than blaming any one individual. If an error occurs in medication administration, ask what systems and processes should be improved rather than fire people.

3. Broadly communicate the issue in terms of the lessons learned and continuous quality improvement. The Institute for Healthcare Improvement espouses Plan, Do, Study, Act. Many IT projects are cutting edge and require incremental fine-tuning. We try, we evaluate, we revise, and we try again. Unintended negative consequences during the learning process require full disclosure and an apology.

4. Do not hide information or sugar coat the events. It is far worse to deny the truth and then have to explain the facts later. In a world of instant communication via e-mail, instant messaging, blogs, and Twitter, assume that everyone knows the facts as soon as they happen.

5. Openly discuss the events, their cause, the immediate corrective action taken, and the long-term changes made to prevent the issue from happening again. Declare that you’ve made a mistake and that you apologize for it. This may be painful and could result in a great deal of short-term publicity, but it’s better than a long-term investigation and future disclosure of management misdeeds. Imagine what would have happened to Bill Clinton if he had said, “I did have an affair with that woman and it was wrong. I have taken short-term steps to prevent any such incidents from happening again, and I will seek counseling from religious mentors and mental health experts to ensure my future behavior is exemplary.” The issue would have disappeared in a few weeks.

In my many years of leading change and making mistakes along the way, I’ve found that great communication, openness, candor, and admission of mistakes—followed by a sincere apology—results in healing the organization and bringing rapid closure to the issue.

— John D. Halamka, MD, MS, is chief information officer (CIO) of the CareGroup Health System; CIO and dean for technology at Harvard Medical School; chairman of the New England Healthcare Electronic Data Interchange Network; CEO of MA-SHARE, a New England regional health information organization; and chair of the U.S. Healthcare Information Technology Standards Panel.