 Great. Well, hi, everyone, and welcome to this month's Patient Safety Movement Foundation webinar. Today's topic will be focused on patient medical and legal perspectives of unsafe care. Before we get started, my name is Sarah Miller. I'm our director of partnerships with the Patient Safety Movement Foundation, and I'm very excited and honored to facilitate today's webinar. So we'll jump into the objectives really quickly. So these are the objectives for today. I will read through them for you all. The first one is understand the different priorities and perspectives of patients, families, clinicians, administrators, and attorneys when dealing with medical harm. The second is recognize how medical areas have historically been handled and why there are such disparities in the way different roles typically respond. Third, consider the impact the current methods of dealing with medical error has on patients, families, and others. The fourth one, discuss the expectations that patients and families should have of healthcare organizations in preventing harm before it occurs and how they can participate in keeping themselves safe. And finally, summarize the steps everyone can take to improve communication, transparency, and respect for each other in dealing with harm when it occurs. So moving on to the CE slide. So today we're really excited to offer board certified patient advocates, CE credit, BCPA. Again, if you are in the live webinar, you will receive one CE hour. So please feel free to email education at Patient Safety Movement with any questions you might have regarding the CE. And again, it will take about five to seven days to process. So a few housekeeping items before we get started. At the end of this webinar, we will have about 10 to 15 minutes of discussion. So up here you'll see we have a chat feature at the very bottom and a Q&A feature. I did want to show the differences between the two. If you do have a question that you want one of our panelists to respond to at the end of this webinar, please shoot it into the bottom right where it says Q&A. It's where the red boxes. And if you have, you know, a comment, a question throughout the webinar that you'd like to kind of have side discussions with other panelists and attendees, you can pop that into the chat. But again, any questions that you want our panelists to answer, please pop that into the Q&A for the end of this presentation. So moving on to this slide, we do have a fun interactive polling feature for today's webinar. It's called Slido. So during this time, I would really encourage all of you that are on this live webinar to log in and there are two ways to log in. You can scan the QR code directly from your cell phone, which is on the right hand side, or you can go to your browser on your phone on your computer and go to Slido.com right here on the left. And then it will prompt you to add in this code. So pound 875-992. Once you type that in, it will take you directly to the live polling teacher. We have two questions throughout this presentation that will give you all the opportunity to answer live. But again, you will need to log in. So again, two options. The right hand side scan your QR code and it will take you directly to this link or join us at Slido.com and put in the code pound 875-992. Okay, so with that said, I will go ahead and pass it over to Luis. I'm very excited today to have him be our moderator. So Luis, would you like to introduce yourself? Yeah, thank you so much, Sarah. It is really a pleasure to be here today with you, with all of you, especially with this excellent panel. My name is Luis Torres Torija. I'm a physician and quality and patient safety coordinator at the Hospital Español in Mexico City and fellow of the Health Care Safety Fellowship of the Patient Safety Movement Foundation. I've been in this role for the last couple of years, and I'm really excited to continue learning and facilitate ways to give a better attention to our patients. So with that, I'm going to introduce our fabulous panelists. I'm going to ask everyone to briefly introduce themselves. Do you want to start calling? Sure. Thanks Luis. So my name is Colin May. I'm a lawyer in Calgary, Alberta, Canada. And I practice primarily in state planning and corporate law. However, I also do some work in professional discipline. And I currently am a commissioner with the Alberta Human Rights Commission and Tribunal, as well as a member of the Provincial Council of the College of Physicians of Surgeons of Alberta. So I deal with the regulatory element for doctors here in Alberta. And I've become, through a family event, I became involved in patient safety from numerous aspects, regulatory, dealing with adverse events, and from the legal side. Thank you Colin. How about yourself, Elisa? Good morning everyone. My name is Elizabeth Caveny. I'm an attorney as well. I'm the managing partner and senior trial lawyer at Caveny and Crow Law Firm in Chicago. I specialize primarily in medical malpractice. So deal with the eight issues of improper medical care or unsafe medical care very often. I have been an ambassador to the Patient Safety Movement Foundation for a little over a year now, and I'm working to improve patient safety in multiple venues. Thank you Elisa. And Regina. Hi, I'm Regina Holiday. I am a patient rights activist. I've been working on this field for 11 years at this point, due to my husband's medical care in 2009 and his subsequent death. I started a series of murals about how to improve healthcare in 2009 and became part of the affordable healthcare debate. And then I began painting hundreds of jackets with people's patient stories. I'm currently in the walking gallery in an attempt to change healthcare policy on a local as well as national scale. I'm currently in seminary and I do serve at four churches, and I'm currently in my chaplaincy at WVU medicine in Morgantown, West Virginia. I live in Grantsville, Maryland in Western Maryland, by Pennsylvania and West Virginia. Wonderful. Thank you all for this excellent presentation. And I'd like to begin by asking our audience to go ahead and use the chat box if they have any questions during the webinar, and we will review it in the final part of the webinar. And with that in mind, let's point ahead and get started. Well, as you know, the term medical error is a preventable adverse effect of care, whether or not it is evident or harmful to the patients. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, behavior, infections, or any other type of ailment. Medical errors often harm and sometimes cause death. So we as clinicians, patients, administrators, families, lawyers, all have different priorities when something happens. And I want to ask Colin, what do you think are the organization's priorities in this matter. Thanks, Lisa. I think for organizations, when an adverse event takes place, sometimes they have conflicting priorities, sometimes it is to learn from it. But often, what you'll find is that the priority is to get over it, get beyond it as quickly as possible, with as little pain as possible to the organization, which often means not disclosing very much about what occurred, and not being that forthcoming with the patient or with the patient's family, unfortunately. And you'll often find that that might conflict even with the clinician. Sometimes you'll see that, you know, the clinician who may have caused the adverse event or been involved in or the group of clinicians are looking. They often do want to resolve it. They want to apologize. They don't like the fact that this has happened. This wasn't their intention, you know, and, but unfortunately, often the organization will try, will quiet them down. You'll end up with management bringing in legal who will tell them, don't talk about it, don't reveal anything, let us deal with it. And so you end up with clinicians being quieted, often families and patients not being given the information they need to find out what happened. And unfortunately, even for the organization, if their goal is to move beyond something as fast as an adverse event as fast as possible, what they often do is end up dragging it out because they force it into a litigious sort of environment. And unfortunately, what that does is it does drag it out for everybody involved. So often the organization is its own worst enemy in dealing with these matters. Yeah, you're completely right, Colleen. And really, in the part of the patients priorities. What do you think are, are these Regina. Well, as far as patients and families when it comes to this regard. There are so many opportunities now due to open data access. I'm a big proponent of the open notes project which has been taking off nationwide and in parts of Canada, where we open up the medical records the family and caregiver can see it, which allows us a little bit more access to what's actually happening in real time, or close to real time. So we get to dealing with these problems much more quickly than the traditional litigious way that was done in the past where it was shut down defend. Don't let the family or patient know what's going on, which caused harm because honestly in the cases of most patients, folks don't do because something went wrong as much as they sue because someone thing went wrong, and they were treated badly at the same time. And that was the kind of frustration that makes people hurt for the rest of their lives honestly. You're completely right Regina. And with that, I'm going to turn this over to the audience members and just like Sarah told you before you can log in into Slido for answering this question. I want to share with you what happened to you. How confident will you feel in knowing that appropriate next step to take. This is a scale of one to five, and being five, the most confident. So you can answer in in real time. I want to share that available evidence from the OECD and the WHO suggests that 134 million adverse events occur due to unsafe care in hospitals around the globe. This contributes to 2.6 million deaths every year. We took an account for example in the US. It is an estimated that more than 200,000 people die each year, making the medical error the first living cause of the precovid. It's now the fourth. And for what I'm seeing in the responses, we really do not feel confident at all about what is the next step to take when an unsafe care happen. And this is worrisome, but this is something that is happening around the globe. And yeah, it's important to take actions about this. And Elizabeth, I would really like your opinion on why is medical error the third living cause of death. Does medicine has become some kind of business. Well, I think it's important for everyone to know that medical errors are the third leading cause of death in the United States. And that's just death that doesn't include medical errors that lead to injuries that and this is only what's reported. So the amount of medical errors that patients are subjected to is an insurmountable amount. And I think it's twofold. I think that the old physician patient relationship no longer exists, where the physician knew the patient kind of from head to toe, all their health issues managed their health, managed consultants that they saw. And that there was one person that cared for a patient. So I think that's the way of the past kind of the old days of house calls are long gone. But more importantly, I think that medicine has become big business, you know, you see, even your, your neighborhood or your local hospital is no longer your local hospital it's now part of a conglomerate a medical system. And so we as patients keep becoming smaller in a bigger and bigger world that our care might not really be the main goal of the end person, which is a large corporation and a board of shareholders. I completely agree. And finishing the question, we can see that there's really, there's a lot of less confidence and well, very confidence is more percentage and taking this from an account, calling historically, what happens when patients point out errors, and how do they typically respond. In this case, there's, there's sort of two parts to that there's immediately in the moment. When you point out an error, perhaps to a clinician, and then there is the response as you move on at following the error. And as Elizabeth said, what can just kind of tweaking off what she mentioned is, because you don't have the same access to a single doctor who may be your family doctor in the same way you used to. Clinicians often work in large teams. Sometimes they don't communicate well with each other and pointing out errors can result in sometimes they'll blame each other. So jousting will happen amongst clinicians, and sometimes they'll blame the patient or the family they simply start off by saying well you didn't do this. You didn't follow your treatment or they'll, if it's in an acute care setting sometimes they will simply say well you're being abusive to me as a clinician, and do I'm to call security or I'll call the police you know, there's a there's often a very visceral reaction that happens. So it can be difficult even in the moment to respond. And then down the road historically what has happened is there is an effort to shut down the clinicians who may want to talk to the patient about or the family about what happened. And it usually involves sometimes that d'arvo acronym of deny attack and reverse victim offender applies while here, because you have a situation where it's often you often look to blame the patient or the family for something that happened. And instead of providing the information to them. So, as Regina said that will get you very, very rapidly into a situation of litigation it's often not the adverse event that leads to litigation, but the denial of the effort to prevent families and patients from experiencing what happened so that's, that's often been what happened. And as that combining with what Elizabeth talks about the sort of more contemporary and more recent situation, where you don't have access to a family doctor who can sit down and speak to you about what happened results in patients and families being left in the cold, so they have to find another solution which often means ending the end up going to a lawyer, unfortunately. And that's a very important point, the, the culture of denying the, the finger pointing the, who's to blame in this kind of situations. And with that, Regina, I would love your opinion about the progress that we have made up today. Well, it's been a challenging time and it is a time of transition, which the beautiful thing about a time of transition is we can do amazing things. As it was mentioned earlier the hospitalist versus the primary care situation. A lot of people in the hospital setting have absolutely new idea what these terms even mean. I don't even know who can be their advocate. What privileges are, you know, where, where can a doctor go in and advocate for you. So, so part of this is on learning with patients in the primary care setting about the wonderful resource of primary care doctor is within the family. One of the reasons you want to have a pediatrician prior to actually having a baby, because that pediatrician can be your advocate understanding that the old system is actually still in place in areas, and they can be someone who could help you. Well, as we go into hospital engaged networks and when organizations that are more focused on hospitals care, then it does become much more important that you be a caregiver advocate or a patient advocate for yourself, and understand the situation that you're currently in. We do need to keep in mind that right now there is a movement called direct primary care. Those are doctors who do not work within the traditional insurance structure. We still do house calls a lot of those folks do. So, so it's one of those things that there are that's another model that's being looked at nationwide. And of course with COVID right now that has changed practice as well. So a lot of people are doing unique care directions like you didn't used to see nurses go out to people's cars and provide care in a car setting. Now think about how many accidents occur when a patient's just trying to leave their vehicle and get into the doctor's office, how many hips are broken just because of a curve that was how to be reached right. So, the fact that we're in this point of chaos to some extent within health care is allowing for us to have some positive change. I also wanted to point out social media that was not really a thing like 1012 years ago. A lot of patients have realized that if they get on Facebook or Twitter and directly from their hospital bed sent out a tweet or post about the care that they're getting, they will get almost real time response to the situation that they're in, which is pretty amazing. When, when you can push your nurse call button and get no action, but when the Facebook manager realizes somebody's yelling to the world about the care, and you get action, then things have changed. So, there's a whole bunch of things going on right now I do also want to focus on electronic medical records. So at this point, most of the nation is using electronic medical records. They're using different systems within those records there are pilot projects right now going on about how we could be include audio files about this patient. It's actually effective for COVID patients where the patients often intubated and unable to talk, but that audio file can give a glimpse of that person's reality, and help the entire team provide better care. The same thing goes for pictures. So if you can give a picture of the person as they lived, not as they sit within that bed or lay within that bed, but their regular face in their regular life that puts you in a different place as far as understanding the patient. So we're utilizing technology in ways that can provide better care and less than errors. Well, Regina, that's, that's really interesting because you're touching this point of the information, the, the transparency, and I can say in the healthcare organizations, the, the current data on patient safety is only estimates. We don't really know how many people are affected each year, because we don't have an accurate measurement method. There is really no requirement that the public being formed of the frequency and severity of all medical errors, or the resulting patient outcomes organizations and physicians often feared being transparent with patients and families about medical issues that have occurred due to a fear of litigation or fault. There's really the certificates do not list the preventable medical error as a secondary or primary cause of death. It's only focused on diagnosis and physical causes such as cardiac arrest or sepsis, for example. And with that in mind, I want to ask another question to our audience. You can log in again to the, to the slide of polling question. And on a scale of one to five, the same five being the most confident. How confident will you feel in being able to get adequate information about the air. And I, you can start responding and we will review this, these results. And I want to ask Elisabeth, what does deny and defend mean for the patient who is hoping to see cancers. And how does it impact everybody. Well, look, I think we have to look at it in a couple of different ways, really to give the benefit of the doubt to the clinician. They have an inherent bias because of who they are and how they're trained. They're trained for instance surgeons, they're trained to do a certain surgery, a certain way, and to take certain steps, and they do a BCD E and the result is F, and that's what they're trained and every day they do a BCD E and F results and they do it 10 times a day. And so they have an inherent bias that I don't know what happened. I didn't do it. I didn't do anything wrong, because number one, they did a BCD E, and F didn't happen something untoward happened. And two, how could they continue to go on? How could they go to the next surgical room if they truly thought they did something in room A that led to the death of that patient. They have to think it wasn't my fault. I didn't do it. I didn't do anything wrong. I was able to go to the next surgery and able to be able to wake up the next day and continue to practice medicine. So I think we have to recognize that clinicians have an inherent bias to admitting fault and admitting medical error. That's the first thing. The second thing, you know, I tell, I spoke at a conference of laparoscopic OBGYNs. I was asked to speak about how plaintiffs attorneys evaluate medical negligence cases. I was the least popular person in the room. I can assure you of that. But one of the things that I said to the physicians is if you would spend more time in your patients room, they would never end up in my room, in my office. They will go to you first for answers to their questions before they will come to me. It is only when they don't get answers to their questions and they don't understand that they will come to a lawyer to try and get answers in questions. Very few situations are situations where the patient comes. They absolutely know what happened. They know what the error was. They know what the basis for a lawsuit is. They're not all wrong wrong site surgeries, you know, or amputation of the wrong leg. They're not. They're often very complex cases that take some time to figure out what occurred. But when they don't get that answer from the clinicians, they will come to an attorney like myself and you might not like the answer that I come up with. It might not even be the right answer. But I will make the time and go through the education and the medical literature and the records and talk to the as many people as I can and try and figure out for the patient what it was that happened. So the lack of transparency, whether forced onto the clinician by the organization or their insurer, or because of their inherent bias to believe that they didn't do anything wrong. The lack of transparency is what will drive them to litigation, or at least to seek legal counsel. I completely agree and in the part of the clinicians is normal that there's some fear regarding the repercussions of error that it can be from this accreditation legal problems to even lose their jobs. The hospitals have traditionally follow a deny and defend strategy providing limited information to the patient and family and avoiding admissions of fault. But there's also I want to share this that there's a growing number of institutions that have implemented a communication and response strategies that emphasize early disclosure of adverse events and a more proactive approach to achieving an amenable solution. We have second victim programs to give support to clinicians after an error where the focus is really on the system and not in the individual. And about the organizations, I will love your, your point of view calling about what does this deny and defend culture mean for the organization culture as a whole. I think for the culture as a whole. Just the learning piece is not there. If, as you mentioned there it has there has been a move to sort of quality assurance reviews that sort of thing on a systemic level. There's been a good element to that and a bad element of we've seen here in Canada, because there, they, there is an effort to learn from these experiences. But often you'll find that that effort itself will cover up some of what happened for the families and the patients because in Canada, for instance in my province in Alberta, under the evidence act. I've brought forward through a quality assurance review which is a systemic look at what happened not about individuals can't be used in any other forum so it's protected information. And when the meeting will happen between the, for instance, maybe the health services or some other organization that is responsible for the care. And when things held with family. They don't discuss findings of an investigation but outcomes of what they're going to do so often you'll find patients and families are looking around staring at each other thinking, well we know less now than when we came in and it gives you a sense that there is still a cover up going on that they're not giving you the information. It's the same thing in the United States and that whenever there's an adverse outcome. Most hospitals will require that a conference and more ability and mortality conference takes place, where some of the greatest minds at the institution will meet will review the records will interview the doctor interview the nurses and make conclusions about what happened and how can we prevent this from happening in the future. It's a beautiful thing, but the patients not invited to it, the patients families not invited to it. They're not, it's completely not discoverable in the United States, anything that's generated or done at that conference is kept confidential from the client and attorney is entitled to find out if an M&M conference took place, but we're not allowed to see any of the documents or any of the conclusions that were reached or changes in protocols that resulted. So it doesn't advance the cause that we're talking about today which is transparency. Yeah, that's exactly what we're seeing here in Canada as well. In an effort to learn. And perhaps a good, I think a good faith effort to learn. Organizations are still perhaps intentionally and sometimes intentionally shutting the family out from that process of learning by turning it into a systems error. And of course, so that will mean families may have to go to a regulator to complain about certain clinicians. And it really, what I'm finding is it, it actually prolongs the problem, because the patients and their families don't feel they've gotten enough information from this systemic review. So they end up dragging doctors and RNs before their regulator. So it just gives this product just extends the process. So I think as Elizabeth mentioned, there has to be a way to bring patients and families into those reviews that make them feel as well that they're a part of it they're contributing to it. But their concerns are heard, and that they're not feeling shut out so that, again, as I said it, we need to avoid that prolonged conflict that goes on, which just harms clinicians as well. Yeah, you're completely right. How can we align really all the efforts of all the, the persons involved in this kind of events. And I want to ask you, Sarah, if it's possible to review the results of the question. Thank you. This is important because this is one of the main things that we want to have with our patients. And really, all the health care system that we have in our different countries, of course, taking an account, the different context is the trust. So what happened when we do not think we're getting the adequate information about an error, and we can see here in the response that 0% feel very confident about the information that they're receiving about an error. And the most percent is really the part of the less confident side. And related to the information, according to studies like the one published by the patient safety movement foundation in their annual poll in US, for example, 87% of the general public have heard a little or nothing about medical error or patient injuries. And overwhelming support about creating more public information about this problem with 82% approximately having more focus on promoting patient safety. So with that in mind, Regina, what can patients, families, and the general public can do about it. So of course, we're somewhat limited in what tools we have a part of it is just embracing the fact that mistakes do happen. So in facilities around the United States for at least the past 10 years I'm aware of there's been the zero harm campaigns, and you'll see all these signs up about zero harm zero injuries, and is that a realistic goal. Truly, do we make mistakes. Yes. So right now this average is one medical error per day during hospitalization. So it's happening consistently. So when we ask people have zero harm zero mistakes, then I don't think we're realistic and what's going to cause understanding of reality. If we let the caregiver in the family and the patient be part of the care team, which honestly prior to COVID they actually were in many cases they were providing care in the room. Hospitals are understaffed. Now of course due to COVID visitation has been limited. So family caregiving in the hospital setting is not what it once was. So if we're truly viewed as part of the care team, then we need to be part of these meetings, we need to be part of the m&ms. As we go deeper into a world where telehealth is a standard of care. Thank you cove it for making that more possible. Then we truly are part of the care team, and we have to be part of all the same information and same documents. When charting occurs, it shouldn't just happen from the care professor professionals, but also from the patient and family themselves, because they are an understanding part of that team. When we talk about systemic problems within healthcare. It's important to remember that this information is not being shared often beyond the hospital system in which it occurs. Patient communities like patients like me and other Facebook groups are doing their best to spread information about systemic harm far beyond the current hospital system in which they are being treated. So we have great hope of progress and change due to what the patient voice can provide within a wider care paradigm and due to access to information. So it's great to spread more of that, which is really important. Yeah, you're completely right Regina and yeah, how can we change this paradigm about this kind of culture that normally we have in our country so it is a bit. How can patients and family members prioritize their goals in the short term and long term. Their term goal for any family or patient obviously is to prevent a medical error right so not even to get into this what we're talking about. And the best way to do that is to have a patient advocate with you when you're dealing with significant medical issues I don't mean when you're going for your annual physical or when you're going for your mammogram but if you know something's wrong. If you have been diagnosed with cancer or you've had a biopsy done and you're going to get the results. Take someone with you. I've been a patient advocate. I'm not a certified patient advocate and I don't mean take a certified patient advocate with you I mean, take someone that you lost that can take notes and can listen. I've been an advocate for both a medical malpractice attorney, a defense attorney and a judge on on two occasions gone with them to their medical appointments. And the questions I hear them say and the misinformation that they walk away from I think, who are you were you in the same room that I was and I was so thankful that I was there taking notes for that person because they were a patient. They weren't with medical knowledge they weren't a judge they weren't a medical malpractice attorney they were just a patient, and I was so glad to be there to be able to take notes and information so always if you're dealing with something, something important, or something important. Take someone with you a friend a family member somebody you can trust. If you don't have somebody hire a patient advocate and make the investment and have somebody go with you that can walk you through the process and help you find consultants and go to the next step. If a medical error does take place, if you've done that but yet something does go wrong. Try to go to the doctor first, talk to the nurses the nurses are often your best friends and the ones that cared for you while you were in the hospital. Talk to them if they're available to you often hospitals and organizations will pull them. And all of a sudden you won't see those same nurses that you had ever again. The surgeon doesn't come to do the follow up appointment and to see how your stitches are coming along. It's a resident only that does or it's an attending or one of his partners so you can't go back to your original doctor but try. Try and talk to the people that were involved. I think going to the organization is a complete and total waste of time. Contacting the organization asking for a meeting with their general counsel or their legal counsel or writing a letter about the doctor or telling them you want some questions answered complete waste of time in my experience. The next step is to talk to an attorney and and get or get your medical records and have them reviewed by a nurse or a physician if you if you have the benefit of somebody like that in your family, or in your circle of friends most people don't. But if you do that's a choice, you know to have your records reviewed, but find a qualified competent attorney. If you have a nurse employed full time I used to have to, I would have them go through the medical records with the patient, and so that they can look through them together and understand them, and they understand our decision on whether we're going to go forward with a lawsuit or we're not. Those are my suggestions on short term and long term fixes, although it's really a system that's broken it needs to be fixed first but if you end up unfortunately in that system. Those are some steps you can take. Exactly. So how do we prevent to this process happen how we developed this trust more than the normal physician and healthcare personnel with with the patient how can we improve this this communication. The patient can be filled as a part of the team, this patient center care attention that is is is really useful. And with that, Colin what should patients, families, and really the general public expect healthcare organization should do about it. I think something that Elizabeth has mentioned is, and this, we are seeing this more we see this in Canada and Alberta we've seen this. You're able to access your electronic records more easily. But as Elizabeth noted, most people look at their like their records and they have no clue what they're telling them. I think that is one of the areas where organizations should be more proactive. If you're looking at your records you want to find out what they mean. They're for most people they're very difficult to understand. There's a lot of jargon there's a lot of acronyms that you will never know what they mean. So watching, you know, medical show on TV a drama is not going to get you there. So I think that's one of the things is just being more forthcoming with the information, but also explaining it to patients and families they need to know what it is now. That doesn't mean you don't end up going to a lawyer, ultimately, to find out more because they may not tell you everything they want you to know that you want to know or that you need to know. I think having that access to the information is important. And as Elizabeth also said, in my experience as well. One of the least helpful things you can do is to go to the organization and complain. The complaints processes often are very opaque. And they will not give you the information again that you need, or they will be very cursory in their investigation without and not look to, to, to lay any blame or to even explain what happened. So you're often better. And Alberta, we have various agencies, you can certainly go to the regulator so that we are physicians board, the College of Physicians and Surgeons does investigations. There are other agencies set up recently Alberta just went through a process where we reviewed the entire complaints process across a number of organizations, including Alberta Health Services, which is the key provider here. We have public health here in Canada, and Alberta Health Services is pretty much it in this province. They are, they are the universal board that provides everything. Not necessarily in primary or long term but what I would say is, you know, we need to have, we should expect organizations to be more forthcoming, more proactive and giving us information. So, when they, they, I think what they need are complaints processes that are independent in many ways, the way you might have an internal auditor and a company, you need a complaints process or an office that is not controlled directly by management and legal stepping in to allow people to make complaints and to get a fair hearing. And that's that those are the things I think we need to look at going down the road. And I mean I'm happy that Alberta has done that where that goes right now that's just sort of in the consideration phase, but I think those are the things we need to see. And more, more ability to see what's going on immediately, more access to those records as Regina said, you can now go online you can make a Facebook complaint and get faster at reaction. And they are end down the hall and tell you're unhappy about something. And that that can be different, a bit different in Canada, maybe from the US because we do have government run healthcare so the reaction is somewhat delayed, perhaps but I have seen many people make a complaint on Facebook, or on LinkedIn or somewhere. And the next day, somebody from Alberta Health Services is is responding to that complaint and saying sorry what did we do wrong let's find out some more information. So I think those are the things that we need from these organizations, and move, we need to move forward with those, and we need to I think to get a sense that you don't want to. You know you don't you don't want to be attacking the family you don't want that to be the culture we need to have that culture of, as Regina has also said, their family was a caregiver patients had to have to be involved in their own care the person centered model of care, which also means the doctors and nurses are also persons ever they're all involved in this care as a team. And you want to protect everybody because of course doctors and nurses don't go to work, generally, saying I'm going to harm somebody. As Elizabeth said, they have a bias to, and in many ways to continue working and to maintain their health, they have to believe that they're doing the right thing. If something does happen, jumping all over them, and harming them doesn't help the situation either. So I think are we need that. We need that from organizations for both patients families and the clinicians. Just to add also, you know, at least half of the people that come to my office, come with a with the mindset that we just want to make sure that this doesn't happen to somebody else. They want to know that there's a check and a balance, and that if something went wrong, it's going to be rectified, not necessarily compensatorily to them, but that it's going to be rectified for the next patient for the next child for the next parent, so another family doesn't have to go through it. You hear about it in criminal cases that families who represent the families of the victim very often don't want the families of the offender to get the death penalty because they don't want that family to be just as ignored as they are. And it's the same kind of thing very often families of victims of medical error, don't want anything horrible to happen to the doctor, they just don't want another family to go through what they went through. And hospitals and organizations very often are doing checks and balances, or making a change in their flow sheet, or adding a box that needs to be checked or adding a stop in the surgery where everything has to be checked time out. But patients don't know that that that's happened as a result of their parents death or their child's injury and how good they would feel if they knew now, you know, call it Trevor's correction or, you know, and Sandy's time out and it would be such a benefit to families to feel like they lost something but it was at the, at the cost of a greater good, a greater good came from it. I think that'd be something really wonderful to see from organizations. Yeah, you're. Yeah, I was going to say I think Elizabeth has hit the nail on the head there. You know, certainly there are situations where people need compensation. They've been harmed. They have maybe permanent injuries that require lifelong care that is expensive and they need to be paid for that. But I think she's absolutely right. Most people are looking at this is what happened, apologize to us, be transparent about it, and make sure it doesn't happen to somebody else, or at least try to diminish the likelihood that it happens to somebody else I mean, as Regina said, you know, mistakes happen, you can prevent every mistake. But if you if an adverse event occurs because there is a flaw in a system or technical flaw, that can be fixed that can be addressed, and that should be passed on throughout the health care system to other organizations to, to other hospitals. And that's what a lot of people are looking for they feel that at least as upset as they are with what happened to them that they're you know humans have this sense that if we can help if we can learn from something that went wrong, and make sure that people are safe and protected, then that's that's an important. That's a very important thing for people to feel that what's happened to them has produced a fact where maybe 100 other people will not now go through that 100 other families will go through that. Yeah, you're making excellent points and really you're talking about the culture, you're talking about patients, families, clinicians, people. So, we all have fears, we all have a different ways to respond. And yeah, I've seen some of the comments about yeah, if a healthcare worker say something about a medical error they will get punished, something like that. This is mainly sadly things that happen right now, and that it does not help to align all the efforts of all the, the people involved to give the best attention possible. Let me see the part of the chat box. We have some questions. I have a question from Edith. Somebody commented on the imperative if that's the right word to not outright lie to the patient after a medical error, our physician denied any role in the action that cause an injury. We got a copy of the medical record a few weeks later from which we learned her claim was untrue. That's when the real rage at what happened began. What do you think about this. Yeah, I think in the United States, there's no law that requires a healthcare provider to confess an error to a family, or to provide accurate information. If they if they know it there's no requirement that they do so. If you've ever seen the movie bleed out, you know that a doctor will say one thing off the record and another thing on the record. But the lies will definitely incite rage and distance the parties from ever reaching any kind of a resolution short of litigation. And we have another question related to this deny and defend culture in the healthcare context is per safety, and we talk about the roles of the patients and the clinicians and the roles from this. How do we actually make the next necessary shift away from defensive and secretive responses to towards a relation restorative and healing response. How do we humanize the response to help her car and what role do non disclosure agreements playing this, who want to answer this this question. Oh, I'd be happy to just address it and if or Regina if you'd like to go ahead. Can we do it together. Sure, sure. The thing that you know you have to look at is, we've got, as I said there's legislation that prevents. We have these quality assurance reviews in Alberta, in Canada. As Elizabeth said they have the same sort of meetings and systemic look reviews in the US. I think one of the things we have to do is just change legislation that allows that to that information to be used more readily to involve patients and families in those discussions in those meetings to give feedback. And other things we'd have to look at is just the training. For instance, I'm involved here at the University of Calgary, our Cummings Medical School working with Hasking Business School is involved it has a course on precision health and medicine, part of which is a quality safety piece, and we were able to present and speak to them in their first week, and I'm continuing to work with them in their ethics and law course about about how to implement person centered care in educational roles and so and that's management as clinicians. That's even their IT people are attending these courses. So I think there's certainly the educational piece, there is changing laws about keeping things quiet. And if you've been incited, for instance, as Elizabeth said, if you're not, if the doctor says one thing and privately and then tells you something else, and then you find out later and you're angry about it. There should be ways and mechanisms to still go back to the organization or to, to the, you know, whether it's the regulator, and to still get a full response where they say well sorry this is an explain why that happened to you. There are a lot of stages through the process where the patient and the family's anger can be brought under control and because they're given the information they were looking for maybe they don't get it first initially, but they that that's a process I think that needs to be put forward is bring make it happen at any time, anytime to this process make sure these people are getting what they need. And if you fail at one stage, do it at the next step. So moving into that. The one thing about non to close disclosure agreements says you never have to sign one. You don't. What's your goal is your goal change in the world is your goal to stop systemic arm. Then it may be more valuable to share your story, all over the world. Talk to reporters, go to meetings. There's oftentimes a place at a place at a conference where you got that chance to ask a question, ask that question in front of 1000 people and watch how fast change can happen. What I love about the current open notes project is now the narrative note is coming before the clinical data flow. So in that narrative note, instead of saying 64 year old man or aggressive wife. It says Bob, or Sally, it's their name. And if you name people and you actually do that, they become real again, and we have the ability through doing that to change things. Yeah, I completely agree. And, and of course we need to take an account, the different countries, the different context of the countries, the societies and how they impacting in the different responses of these kind of things for the a clinical part for the organizations for the, the patients by itself. Well, discussion to have about how everybody's role and how we all fit in together when it does happen. But I think we can't lose sight of the fact that it is the third leading cause of death in the United States. And that's really where the fix has to come first. Perfect. Thank you, Elizabeth. Well, this was a very enjoyable. Thank you to all the panelists for being here and have this important conversation. Thanks to the patient safety movement foundation for this opportunity. And also to the audience for being so engaged and join us during the webinar. If there's some questions that were on respond, we will try to do it and publish after after this. I'm going to turn it over to Sarah to give the final details of the webinar. Thank you, Louise and just to echo what Louise said, if we didn't get to your question. I do see that there were a few in the chat and we'll be sure to hand those over to our panelists after this webinar and they will respond to those and we'll send that out shortly. A few housekeeping items I just want to remind everyone here at the patient safety movement we strive to present the highest quality educational content completely free of charge. And as a non profit that relies on donations from individuals we do ask that you consider helping us keep these webinars going by visiting our website and donating what you can. And then last but not least just to reiterate the continuing education credit information. This webinar does provide one C e credit for BCPA so please email us if you have any questions at all if you attended the live webinar. I think it's about five to seven days to process but again thank you so much to everyone that joined us and we hope you enjoyed this webinar and have a great rest of your day. Thank you Sarah. Good luck everyone. Thank you.