The offer of compensation or restitution is a key element in the apology process after patient safety incidents. In his book Healing Words: The Power of Apology in Medicine, Michael Woods makes the point that in most other industries, apology and compensation are seen as ‘part of their professionalism and customer service‘. In her book After Harm: Medical Error and the Ethics of Forgiveness, Nancy Berlinger also stressed that apology and compensation ‘are intimately linked as ethical responses to harm’. Arguing that compensation is a part of repentance, a critical stage which lies between apology and forgiveness, Berlinger conceived of compensation as a form of reparation which helps to repair damaged relationship, something a verbal apology alone cannot achieve. She therefore argued for a fair compensation system for all patients who are harmed by adverse events, maintaining that such restitution should not be restricted to a tort system of personal injury lawsuits which benefits only a few injured patients.
The subject of compensation as part of the apology process was also the focus of the paper by Doug Wojcieszak and colleagues titled The Sorry Works! Coalition: making the case for full disclosure. There, they asserted that the apology process is only satisfactory if it is allied with what they call ‘up-front compensation‘, explaining that ‘without compensation, patients and families might view an apology as flippant or not meaningful and become even angrier and more likely to pursue litigation‘. Similarly, Jawahar Kalra and colleagues, in their paper titled Disclosure of medical error: policies and practice, emphasised the value of the obligation of a ‘duty of candour’ whereby physicians ‘inform a patient of an act of negligence or omission that causes harm’, and this goes along with an offer of a compensation package which enables patients to ‘waive their right to litigate‘.
In the next blog post, we will look at the resolution of patient safety incidents when the disclosure-apology-compensation system fails.