Abstract
BackgroundMany healthcare organizations have developed disclosure policies for large-scale adverse events, including the Veterans Health Administration (VA). This study evaluated VA’s national large-scale disclosure policy and identifies gaps and successes in its implementation.MethodsSemi-structured qualitative interviews were conducted with leaders, hospital employees, and patients at nine sites to elicit their perceptions of recent large-scale adverse events notifications and the national disclosure policy. Data were coded using the constructs of the Consolidated Framework for Implementation Research (CFIR).ResultsWe conducted 97 interviews. Insights included how to handle the communication of large-scale disclosures through multiple levels of a large healthcare organization and manage ongoing communications about the event with employees. Of the 5 CFIR constructs and 26 sub-constructs assessed, seven were prominent in interviews. Leaders and employees specifically mentioned key problem areas involving 1) networks and communications during disclosure, 2) organizational culture, 3) engagement of external change agents during disclosure, and 4) a need for reflecting on and evaluating the policy implementation and disclosure itself. Patients shared 5) preferences for personal outreach by phone in place of the current use of certified letters. All interviewees discussed 6) issues with execution and 7) costs of the disclosure.ConclusionsCFIR analysis reveals key problem areas that need to be addresses during disclosure, including: timely communication patterns throughout the organization, establishing a supportive culture prior to implementation, using patient-approved, effective communications strategies during disclosures; providing follow-up support for employees and patients, and sharing lessons learned.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1903-7) contains supplementary material, which is available to authorized users.
Highlights
Many healthcare organizations have developed disclosure policies for large-scale adverse events, including the Veterans Health Administration (VA)
We found that there were many aspects of communication and decision-making related to VA’s disclosure policy where we needed additional information to fully understand the implementation of the disclosure policy
Employees relied on informal communications channels when they did not receive formal communications from leaders: “And there were a lot of different stories
Summary
Many healthcare organizations have developed disclosure policies for large-scale adverse events, including the Veterans Health Administration (VA). Implementing a national policy for disclosing large-scale adverse events to patients is a complex process. Healthcare organizations struggle with whether and how to notify patients when there is no known disease transmission [4] Disclosures of these adverse events seek to give patients an accurate description of the risk, while maintaining their trust, by communicating both what is known and unknown about the event [5]. Some healthcare organizations like the Veterans Health Administration (VA) have mandates to notify patients of these events in an effort to be transparent and maintain trust in addition to ensuring that each patient involved in the adverse event is able to take any necessary action for their health and well-being
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