Apology Revisited

Early on, I did a blog entry on apology. I even included apology in 107(1) of the Model Ethics Code, as a stated option for officials, so that their municipality does not have to go to the trouble of investigating their actions and holding hearings.

Yesterday, I attended a lecture by Nancy Berlinger of the Hastings Center in Garrison, NY on apology in the medical context. I think government officials, whom she cited as those having the greatest problem apologizing, could learn a lot from what medical professionals are doing. Like medical professionals to their patients, government officials have strong obligations to their constituents and can do them a great deal of harm.

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For example, some hospitals are holding 'Near-Miss Rounds,' in which they analyze serious mistakes that have recently been made and discuss how to prevent such mistakes in the future. The goal is to stop working around problems, which allows them to remain and get worse, and instead improve processes so that the problems are dealt with when they are discovered and prevented from recurring.

Medical professionals are learning the difference between expressing sympathy and apologizing. In both cases, the words 'I'm sorry' are used, but in an apology, professionals take accountability for the suffering caused. They do not say, 'I'm sorry if you were hurt,' but 'I'm sorry I hurt you, and what can I do to make things better?' How often do government officials say this?

The most important point made by Ms. Berlinger was that failure to truly apologize not only adds insult to injury, but triggers lawsuits. Medical professionals are afraid to apologize because they consider it to be a confession of guilt that could be used against them in a lawsuit. This turns out not to be true. Patients are less likely to sue a medical professional who apologizes up front and discusses compensation. Often patients sympathize with and forgive the medical professional.

This is equally true of government officials. The coverup is worse than the crime. Everyone knows this, but so many officials believe they can get away with it if they make a big enough smokescreen. And often they do. But at what cost, to them and, most important, to the public? People are forgiving, but not when you refuse to respect them and recognize the harm you cause.

Hospitals are requiring full disclosure of any mistakes made. When the University of Michigan hospital required full disclosure, it had 262 open malpractice suits. Within a couple of years, the number had fallen to 100, and litigation costs had fallen dramatically. Along with full disclosure, they insisted on swift and fair compensation even for such things as delays, but refused to settle nuisance suits. When their medical professionals were to blame, they acted quickly and fairly. When they were not to blame, they did not. With full disclosure, medical professionals also found it easier to learn from their mistakes, because they were all there for everyone to see.

Government officials too need to have full disclosure and complete transparency. It will dramatically lessen the number of ethical mistakes, cut corruption, and make the public feel more trust in their government.