Work needed to eliminate emotional harm to patients


While hospitals have made significant strides to reduce or eliminate physical harm to patients, they now need to reduce emotional harm, according to a report.

In the paper published in BMJ, patient care leaders at Beth Israel Deaconess Medical Center (BIDMC) say hospitals need to work on eliminating emotional harms that damage a patient’s dignity and can be caused by a failure to demonstrate adequate respect for the patient as a person.

“Emotional harms can erode trust, leave patients feeling violated and damage patient-provider relationships,” writes lead author Dr Lauge Sokol-Hessner, a clinician in the BIDMC Hospital Medicine program and the associate director of inpatient quality. “Such injuries can be severe and long-lasting, with adverse effects on physical health. Failure to acknowledge and systematically address these harms ensures that they continue.

“For these emotional harms, we are where we were with patient safety before 1999: we know they occur but lacking a systemic approach to capture, categorize or assess them, we struggle to understand root causes and prevent future events. We do not have reliable estimates of how often such harms occur, but some evidence suggests that they may be more prevalent than physical harms.”

Previous studies have shown patients often emphasize emotional rather than physical harm in discussing adverse events. Such harms may include a failure to conduct a sensitive conversation in a suitably private setting; misplacing or losing sentimental objects; or “never events” such as sending a funeral home the wrong body after a patient passes away.

“Ensuring that our profession does not cause preventable harm to our patients requires that we address emotional harms with the same rigor we have applied to physical harms,” added Kenneth Sands, senior author and BIDMC’s senior vice president of healthcare quality and chief quality officer at the Silverman Institute for Health Care Quality and Safety.

“A reliable culture of respect for patients almost certainly requires a culture of respect among organizational leaders and staff,” added co-author Dr Patricia Folcarelli, senior director of patient safety at BIDMC.

The authors stress that health care facilities must also identify and acknowledge personal and systemic factors that may be associated with emotional harms, such as a lack of training, a stressful work environment or faulty systems of care.
Reported cases of loss of respect need to be reviewed with a root cause analysis similar to ones used for physical harm because “our early experience with emotional harms is that they are often the result of multiple failures.” These failures might involve not only the provider’s skills and attitude but also the work environment, information technology systems and care team communication.

BIDMC; BMJ; Dr Lauge Sokol-Hessner; Kenneth Sands; Dr Patricia Folcarelli;