Table 3

APICCTHS Model: Involving patients and families in adverse event reviews

Key recommendationsDescription
ApologySay the words ‘I am sorry' or 'I apologise’. This should be timely (soon after the event). Show empathy ‘I feel ashamed, uncomfortable, embarrassed that we let you down’ or ‘that we didn’t get things right’, or ‘we fell short of the standard expected’.
Person-centredAsk what matters to the patient and family. Record this and respond to this as part of the review process (often it is not what clinicians or reviewers think might be important to patients and families).
InclusiveExplain you are interested in finding out why the adverse event happened and ask the patient or family for any insights they would like the review team to consider, actively listen and acknowledge these.
CommunicationRemain empathetic, even in situations fraught with anger or frustration. Be open to hear personal criticisms without withdrawing or becoming defensive.
Closing the loopShare learning with patients and families ‘what we have learned from this is….’ or ‘Here is what we will do to avoid this happening again’. This should be communicated in a way that fits patient and family’s needs (minimal use of jargon). Learning should be re-visited to ensure recommendations continue to be actioned.
TimingProvide regular updates throughout the review; explain what you are doing to find out what happened. Communicate what you know, include and acknowledge suggestions made by patients and family.
Heart of reviewPut patients and their families at the heart of reviews. Actively listen to their accounts, they may have vital pieces of information to enhance learning. Patient and families experience is their truth and should be represented as part of the review.
Support for staffCreate just culture and psychological safety for staff (as second victims). Focus on learning and not blame; ask what was it in the system, environment, tools that contributed to the event?.