For an organisation to get things wrong is no big deal. Well, let me start that again; it can be a very big deal. I guess it depends on what it is. However, in the normal run of events, getting something wrong is not the issue. The issue is; how well and quickly things are recognised and put right. How fast things are put in place to make sure it doesn't happen again.

Dealing with complaints isn't that difficult. Listen, sympathise, don't justify, make notes, agree a course of action and follow through. Six simple steps I've been banging on about for ages.

Equip and empower the patient-facing front-line of care to handle complaints and say 'sorry' is a simple way to make sure they don't become grievances.

The latest NHS initiative is 'saying sorry'; based on the extended duty of candour (Summary here). On the face of it a good thing; why not. It has arrived as part of the fall-out from the Francis Inquiry.  It's not entirely new.

As far back as 1955 the doctor's indemnity company, the MDU, advised its members to give an explanation if something goes wrong. In 1998 the GMC said it was a doctor's 'ethical duty to be open if things go wrong'.  In fairness, if I remember rightly, they stopped short of 'sorry'.

It seems to me patients and the public are people like us. What would we want if 'something went wrong'? I'd like to know why, what are the consequences and can anything be done to put it right. I'd probably be interested in knowing if it was likely to happen again, to someone else, like me. I'd wanted to be treated kindly and intelligently.

Saying sorry? Well, better safe than sorry, seems to be the watchword of the NHS... with all the wrong connotations?

When organisations say 'sorry' you can bet the words have been poured over by the legal department and groomed by the PR people. Corporate 'sorry' tends to leave me unconvinced.

A personal sorry is quite another thing.

A while back The Wall Street Journal ran a story; an anaesthetist inadvertently injected a pain killing drug in the wrong place, causing the patient's heart to stop. Emergency, open-heart surgery revived her.

The family were furious and wanted retribution. Breaking with convention the doctor wrote and said sorry and later met the family and apologised in person. The family were moved by the act of contrition and dropped the law suit.

The pressure from lawyers and insurers to say as little as possible, in case it is interpreted as an admission of liability, is only compounded by the hounding that professionals get from the likes of the NMC and the GMC, who appear bystanders in labyrinthine processes where registrants wait months for hearings; careers are destroyed and the rumour mill runs riot.

The Vanderbilt University School of Medicine in Nashville has courses in communicating errors and apologising; they are mandatory for medical students.

Saying sorry is the right thing to do. Of course it is. But, unsupported, it is a huge gamble. A gamble with a career, a gamble with a livelihood and a roll of the dice for the future.

As medical negligence claims get bigger, lawyers more carnivorous, it is in everyone's best interest to avoid the courts and their consequences but candour will only work if the corporate mind-set allows it.

In 1999 at the Lexington Veterans Hospital, following two huge hits for medical negligence in the 80's, they developed the concept of 'extreme honesty'. The hospital told staff that every medical error must be disclosed fully and immediately. Doctors and staff apologised to harmed patients and their families and proposed ways to prevent recurrence. Settlements and pay-outs took a dive.

Proper research is scarce but the data points to a sincere and prompt apology avoiding grief and costs.

In the NHS honesty looks like an optional extra. Doctors can hide their mistakes and nurses close ranks and we all know about the Mesperyian delights whistle-blowers are subject to.

In the US, Colorado and Oregon have a great idea.  They passed laws making it impossible for an apology to be used against a clinician in any subsequent proceedings.

A law to make it OK to say sorry is one thing; we need another law (US style) to make sure those who are brave enough to say it don't, themselves, end up being sorry they've said it. 

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