Shifting nursing home culture from “deny and defend” to “disclosure and apology” when medical mistakes are made can improve job satisfaction and help stem burnout among employees, according to new research.
Although the study focused on acute-care hospitals, a healthcare consultant who specializes in the CANDOR method of being transparent, apologizing for medical errors, and working with families instead of stonewalling explanations could improve workplace satisfaction in SNFs.
The study, published Thursday in JAMA Network Open, looked at how applying the CANDOR method at acute-care hospitals can increase workplace satisfaction and trust in senior leadership. Those two issues factor significantly into staff burnout and turnover, the research team noted.
This method, pioneered by the University of Michigan in the early 2000s, represents a major paradigm shift for healthcare systems by removing “blame and shame” when medical errors resulting in unexpected patient harm are made, said consultant Doug Wojcieszak.
“When something goes wrong — which happens often in nursing homes — the historical response of ‘blame and shame’ creates a culture of fear,” Wojcieszak told McKnights Long-Term Care News on Thursday. “No one talks, and workers wind up leaving because they don’t feel that they’re respected or valued. If a CNA or nurse makes an honest mistake because the system is bad, that’s because of a bad system — not a bad clinician.”
The three main points of focus of the method are 1) improving safety and quality of care and preventing patient harm; 2) supporting patients, families, and caregivers; and 3) reducing litigation frequency and costs, according to the Agency for Healthcare Research and Quality, a part of the Department of Health and Human Services.
Fully implementing CANDOR is labor intensive and costly, but with the historic workplace issues impacting nursing homes, providers could find the costs justified, experts said.
“CANDOR programs in particular may be fertile ground for improving worker satisfaction and, with it, hopefully retention,” said lead study author Andrew I. Friedman, PhD, with the Department of Economics at the University of Colorado Denver in a press release announcing the study. “It may not be enough for healthcare workers to take pride in their work. They may be more likely to stay when they can also take pride in how their institution handles itself.”
Wojcieszak said that in one case involving the death of a nursing home patient, open conversations with the family about what happened led to the family requesting a plaque in the dining room honoring the resident and acknowledging the lessons learned.
“There’s huge liability issues in the senior living space,” Wojcieszak said. “There’s a lot of guilt and emotion around their family member being [in a nursing home]. If you can get people in a space where they can have an adult conversation, you can find out what they need.”
