The power of an apology

November 2016   Comments

Heidi Domke looks back at apologies she did and did not receive and encourages health-care providers to say those simple little words

“I’m so sorry.” Those were the first words I heard from my manager. I was lying on a gurney in the emergency department after I was brutally assaulted by a patient twice my size. Those were the words I would repeatedly hear from her during the next year, while on light duty as I recovered from my concussion.

I suffered nightmares for several months, awakening my family as I screamed, envisioning my attacker coming at me once again.

As time passed, my body began to heal and my head began to clear. I felt differently about the incident. My manager continued to apologize whenever she saw me. One day, about eight months after my ordeal, still nauseated, I stopped by her office and asked, “Have you heard of the Apology Act?” She looked at me with somewhat of a blank stare and said, “No. I just believe that a big part of my job involves listening to people and apologizing when things don’t go right.” I then shared with her what I knew of the act and how her efforts had been key to my process of reconciliation.

I first heard of the Apology Act shortly after it became law in British Columbia in 2006. I had attended a presentation that was being given to health-care professionals. The presenter was the director of risk management for the local health authority, who was strongly advocating for apologies when errors or gaps in care occurred. This hit home personally. Just a few months before the presentation, my mother became catastrophically disabled during an emergency department incident. After the presentation, I approached the director and shared my mother’s story.

Having heard him speak passionately about this approach, I hoped not only for an apology, but also for the beginning of a discussion, the recognition of a learning opportunity for the health authority so that no other patient would have to endure what my mother had. The pain of what happened to my mother and how it has affected our family has not lessened with time. An apology would have made a world of difference for us. Yet, we have not heard from the health authority.

Most Canadian provinces and territories, more than 30 U.S. states and numerous countries around the world actually have laws about apologies. Quite simply, an apology is an expression of sympathy or regret and indicates that one is sorry for what transpired. By law, saying “I’m sorry this happened” does not usually constitute an admission of fault or civil liability nor is it generally admissible as evidence of either. Also, insurance coverage for the person or organization offering an apology is not typically affected.

Apologizing in the health system evolved when physicians, nurses and other health-care providers realized that this simple act could help the healing process. By acknowledging the situation and opening lines of communication, the patient, family and care providers can process the event. A discussion creates a venue for learning and practice improvement to help prevent a similar situation from occurring in the future. Health-care institutions in regions where an apology act is in place (or where an evidence act includes apologies) should have policies outlining the process and who may give an apology. Nurses should know their institution’s expectations related to these policies.

The act of apology is simply about saying, “I’m sorry this happened to you.” It promotes healing, learning and dialogue that is beneficial to all involved. Remember, the body and the mind will each heal on its own separate timeline.

Editor’s Note: The views expressed in this column are those of the author and do not necessarily represent the policies of CNA.

Heidi Domke, RN, BSN, MBA/HCM

Heidi Domke, RN, BSN, MBA/HCM, works in acute care in Victoria and in Portland, Ore., and is vice president of patient care for a staffing company in New York.

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