Eliminating emotional harm for patients: 5 takeaways

A recent BMJ Quality & Safety article suggests emotional harm from disrespect in healthcare settings is a "neglected preventable [patient] harm" that should be addressed with the upmost importance.

The article — which was authored by patient care leaders at Beth Israel Deaconess Medical Center in Boston — defines emotional harm as "harms to a patient's 'dignity' which can be caused by a failure to demonstrate adequate 'respect' for the patient as a person."

Here are five takeaways about emotional harm from the article and what BIDMC is doing to combat the problem.

1. Emotional harms may include failing to conduct a sensitive conversation in a suitably private setting; misplacing or losing sentimental objects; or committing "never events" such as sending a funeral home the wrong body after a patient passes away.

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

3. To try to reduce patient harms, BIDMC made a significant commitment to defining the loss of dignity and respect as a preventable harm and taking active steps to prevent them by convening a multidisciplinary "Respect and Dignity" Workgroup. The workgroup defined emotional harm as something that affects a patient's dignity by the failure to demonstrate adequate respect for the patient as a person, a definition that acknowledges that not all emotional harm is a consequence of a human failure to demonstrate respect.

4. The BIDMC group made a commitment to identify and track emotional harms using the same databases used to document physical harms. The article authors suggest other healthcare facilities 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 — as well as conduct root cause analyses for emotional harm events.

5. The authors recognized that there are considerable challenges to preventing emotional harm, including establishing an operational definition of 'respect' across culturally diverse patient populations.



More articles on patient harm:
Report reveals many patients endangered by dietary errors: 5 risk-reduction strategies
Emotional harm: The overlooked patient harm
25 lessons from a patient survey of adverse medical events

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