How to Say I'm Sorry: A Study of the Veterans Administration Hospital Association's Apology and Disclosure Program

Bibliographic Details
Main Author:	Carmack, Heather J.
Language:	English
Published:	Ohio University / OhioLINK 2008
Subjects:	Communication medical mistakes health communication apology patient safety
Online Access:	http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1209039528

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spelling	ndltd-OhioLink-oai-etd.ohiolink.edu-ohiou12090395282021-08-03T05:45:41Z How to Say I'm Sorry: A Study of the Veterans Administration Hospital Association's Apology and Disclosure Program Carmack, Heather J. Communication medical mistakes health communication apology patient safety <p>Medical mistakes are the "hidden epidemic" of medical care. The number of medical mistakes continues to rise, but patients, medical providers, and hospitals remain silent about mistakes. I join the scholarly and practical discussion about medical mistakes through a case study of the Veterans Administration Hospital Association's Apology and Disclosure Program. This program, created 21 years ago at the VAMC in Lexington, Kentucky, was the first program in the country to remove the secrecy and silence surrounding medical mistake experiences. At the VAMC, physicians openly disclose bad outcomes and potential mistakes to patients, and the hospital issues an apology and offers compensation when a mistake does happen. In this dissertation, I provide the first in-depth communicative analysis of the program and offer an interpretation of how multiple medical and hospital stakeholders make sense of organizational policies and external exigencies that enable and constrain the practice of medicine. Using narrative and structuration frameworks, I employ three methodologies to collect discourse related to the VAMC program and medical mistakes: in-depth interviews, participant observation, and document analysis. </p><p>The results are encapsulated in five themes which include discussions of issues related to the bureaucratic organizational structuring of hospital policy, narrative expressions of mistakes, the discursive and material consequences of mistakes, the emotional redemptive journey through mistakes, and the question of ethical action in health care. Woven throughout these five major themes are issues of co-ownership of mistake experiences, control and authority, and ideological and ontological questioning about the role of professionalism in medicine. </p><p>The results of the data collection and interpretation are used to answer four research questions. Ultimately, I argue that the VAMC disclosure and apology program attempts to re-envision medical mistake narratives, providing multiple stakeholders new scripts through which to interact with patients and practice medicine. The analysis attempts to enlarge the societal scripts about medical mistakes and the cultural practice of medicine. I underscore the complexity of practicing "socially responsible" medicine in the face of inevitable mistakes, managed care, and the bureaucratic organizing of medicine. Theoretical and practical implications for the VAMC program, limitations of the study, and directions for future research are also discussed.</p> 2008-07-18 English text Ohio University / OhioLINK http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1209039528 http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1209039528 unrestricted This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws.
collection	NDLTD
language	English
sources	NDLTD
topic	Communication medical mistakes health communication apology patient safety
spellingShingle	Communication medical mistakes health communication apology patient safety Carmack, Heather J. How to Say I'm Sorry: A Study of the Veterans Administration Hospital Association's Apology and Disclosure Program
author	Carmack, Heather J.
author_facet	Carmack, Heather J.
author_sort	Carmack, Heather J.
title	How to Say I'm Sorry: A Study of the Veterans Administration Hospital Association's Apology and Disclosure Program
title_short	How to Say I'm Sorry: A Study of the Veterans Administration Hospital Association's Apology and Disclosure Program
title_full	How to Say I'm Sorry: A Study of the Veterans Administration Hospital Association's Apology and Disclosure Program
title_fullStr	How to Say I'm Sorry: A Study of the Veterans Administration Hospital Association's Apology and Disclosure Program
title_full_unstemmed	How to Say I'm Sorry: A Study of the Veterans Administration Hospital Association's Apology and Disclosure Program
title_sort	how to say i'm sorry: a study of the veterans administration hospital association's apology and disclosure program
publisher	Ohio University / OhioLINK
publishDate	2008
url	http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1209039528
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How to Say I'm Sorry: A Study of the Veterans Administration Hospital Association's Apology and Disclosure Program

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