Tell & Repair


1. Harvard Consensus Statement 2006
2. Tell & Repair legal provision
3. Developments Tell & Repair September till December 2007
4. Developments Tell & Repair February till March 2008
5. Report Conference Victims of Medical Errors, April 23 2008 Utrecht Netherlands.
6. Spring 2008: publication Canadian Guidelines for Disclosure.
7. Veterans Health Administration (USA) adopts disclosure and remedial medical care for iatrogenic patients

1. Harvard Consensus Statement 2006

Spring 2006 the Harvard Hospital Group published the Harvard Consensus Statement: When things go wrong: Responding to adverse events. Click here to download the report.

This group consists of sixteen Harvard Teaching Hospitals.

The paper is organized in three major divisions:
1. The Patient and Family Experience
2. The Caregiver Experience
3. Management of the events.

Each section has three parts:
1. A brief summary of expert consensus about the issue
2. The reason and evidence behind consensus
3. Recommendations

The Harvard Hospital Group recommends to adopt the following principles:
- full, open and honest disclosure to the patient on the medical error and the damage
- providing genuine follow-up diagnostics and remedial medical care to mitigate the damage

This report is of major importance to the improvement of the position of victims of medical errors and patient safety. Therefore its recommendations should be implemented as soon as possible in Europe and globally.


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Tell and Repair proposal for legal provision, June 2007.

Tell and Repair provision as extension of Laws on Medical Treatment Agreement. June 2007, to be implemented as soon as possible, ultimately January 1st 2008. Based on Harvard Consensus Report(2006) When Things Go wrong: Responding to Adverse Events, discussed at workshop Position of the Patient by Sophie Hankes SIN-NL/IEU-alliance Congress Blamefree Reporting, KNMG Utrecht, 24 November 2006.

What is the wish of a patient when he/she is damaged by a medical error? Put yourself in his/her place: what would I want if I were hurt by treatment? What is the right thing to do? Guiding principles concerning disclosure directly after the medical error:
1. Report only the facts of the error, what happened.
2. Give reliable information as soon as this is available.
3. Explain which follow-up diagnostics and remedial medical care are recommended.
4. Explain the implications for the prognosis

Open and full disclosure:
1. Tell the patient and family what happened.
2. Take responsibility.
3. Apologize.
4. Explain that the error will be examined.
5. Explain what will be done to prevent recurrence of the error.

Who and how to communicate:
1. A trusted caregiver should lead the initial communication.
2. The person responsible for next steps in care should lead subsequent communication, possible in presence of person of choice of patient/family.
3. Include primary nurse in communication, if this is the wish of the patient/family.
4. Include member of staff with special communicaton skills.
5. Choose a quiet, neutral area for communication, not the room of the CEO.

Follow-up communication:
1. Conduct follow-up sessions promptly. Apologize in case of delay.
2. Physician who is responsible for care should lead sessions. Involve CEO in case first communication was not successful.

Support and follow-up medical care for the patient, family and caregiver:
1. Take each patient/family concerns serious and be respectful.
2. Maintain the therapeutic relationship, provide appointments. Do not abandon the patient.
3. Put all billing on hold pending analysis of the event.
4. Investigate possible means for providing financial support and provide if necessary financial compensation.
5. Provide if necessary psychological and social support. Provide if necessary psychological counselling for the physician/nurse who caused the error.

After the medical error the following is essential:
  • honest and open information : what happened.
  • follow-up diagnostics to determine the damage and follow-up remedial medical care to mitigate or repair the damage.
  • registration and examination of the error to prevent recurrence and to learn from errors.


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    3. Developments Tell & Repair September till December 2007

    On the 19th December 2007 Nico Oudendijk Deputy Inspector General Inspectorate of Health Care has signed the Tell and Repair legal proposal on request of Sophie Hankes SIN-NL / IEU-Alliance. On the 7th of November 2007 the Association of Medical Consultants, the Association of Hospitals and the Association of Nurses and Caregivers in the Netherlands agreed to formulate a proposal before the 15th of March 2008 to improve the aftercare to the present and future victims of medical errors. They agreed to base the proposal on the Tell and Repair legal provision.

    October 2007:
    Meeting with Dutch Association of Medical Consultants and Dutch Association of Hospitals on Tell and Repair legal provision positive.

    September 2007:
    Acknowledgment by Association of Medical Consultants that follow-up care to victims of medical errors is nil.

    IEU-Alliance proposes Tell and Repair legal provision

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    4. Developments Tell & Repair February till March 2008

  • On the 13th of February 2008 the Dutch Ministry of Healthcare wrote:
    • - that they attach much value to honest information and remedial medical care to victims of medical errors
    - that they would imply the Tell and Repair provision in their considerations in the preparation of the new law Client and Quality of Care, letter available.

  • On the 10th of March 2008 the Dutch Association of Hospitals, the Association of Medical Consultants and the Association of Nurses and Caregivers Netherlands wrote:

    • - that they will organise a conference on the 23rd of April 2008 to list the wishes of victims of medical errors and
    - that the Tell and Repair provision will be formulated as an official NTA protocol at the end of 2008.
    Certainly it is important that the need for improvement of honest information and respectful adequate treatment of victims of medical errors is acknowledged and subject of serious discussion. However we emphasize that sofar no actual progress has been realized. So far the improvement of the position of victims is only a matter of words and not action. It should be clear that many victims are in desperate need of actual medical assistance. We stress the urgency of the situation and appeal to all active in healthcare to speed up the process to achieve true patient safety, not only for the future, but also and especially for the present.

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    5. Report Conference Victims of Medical Errors, April 23 2008 Utrecht Netherlands.

    April 23rd 2008 the medical field organised the first national conference for victims of medical errors. The Dutch Association of Hospitals, (NVZ) representing 100 hospitals, the Association of Medical Consultants, (OvMS) representing 16.000 physicians and the Association of Nurses and Caregivers (VenVN), representing 200.000 nurses and caregivers were present as well as consumers, patients and victims organisations. The conference was organised as a result of strong pressure by SIN-NL and the IEU-Alliance. This was acknowledged by all present.

    These are the results of the conference:
    The Chair of the meeting Ms Marian Kaljouw Ph.D. Chair of the Nurses expressed her deep shame about the fact that the medical field so far does not or almost does not give care to victims of medical errors. The NVZ and the OvMS did not contradict this statement and were silent. We compliment Marian Kaljouw with her honest and courageous statement.

    The entire meeting was and acknowledgment of the horrible situation of victims of medical errors and their relatives. The consumers, patients and victims organisations proposed the following:
  • the immediate release of honest information
  • the immediate arrangment of adequate remedial medical care to limit the damage.
    • Both represent the essence of the legal provision Tell and Repair of SIN-NL/IEU-Alliance.
  • the immediate release of the medical records to the victims and their relatives
  • SIN-NL/IEU-Alliance proposed to give a copy immediately after each consultation to the patient in order to enable them to approve the contents. Thus incomplete or incorrect records can be prevented, as mentioned in the NIVEL report of 2007.
  • to oblige physicians, nurses and hospitals to learn from their errors.
  • the Council of the Disabled and Chronically Ill made a remarkable proposal to install instantaniously a high fine on the refusal of honest information and remedial medical care. They also pleaded for a more active and efficient attitude of the Inspectorate of Healthcare. We certainly do agree with both proposals.
  • the Consumersfederation pleaded for more transparency and publishing of medical errors, including those who are sent to the Inspectorate of Healthcare. We support this.


    • It was acknowledged that medical assistance to the present victims of medical errors has to be organised short term and that one should not wait for guidelines or laws. We do regret that the medical field so far refrained from formulating their reaction to our legal provision Tell and Repair which has been signed by the Inspectorate of Healthcare and which has been approved by the lawyer J. Legemaate of the Dutch Association of Physicians and will be dealt with by the Ministry of Healthcare in the preparation of the new law Client and Quality of Care. We emphasized that the rendering of honest information and remedial medical care is part of the regular and legal obligations of physicians and nurses. Therefor the use of the word aftercare was abandoned. Within four weeks another meeting will be organised to develop a practical plan to improve the situation of the present and future victims of medical errors and their relatives. SIN-NL and the IEU-alliance were represented by Peter van den Berk and Sophie Hankes, and two members of staff.

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    6. Spring 2008: publication Canadian Guidelines for Disclosure.

    Good news! On March 18th 2008 the Canadian Institute for Patient Safety has published the first Canadian Guidelines for dealing with victims of medical errors: the Canadian Disclosure Guidelines. Page 34 Appendix E publishes the procedure and checklist. These guidelines are based on respect for the victim which are expressed in the following: priority is given to presenting the facts and of direct arrangement for the safety of the patient and direct measures for follow-up diagnostics and remedial medical care, to limit the damage of the errors. The guidelines also insist on informing the patient that the error will be analysed and which measures will be taken to prevent reoccurence. It is advised to apologize. It seems that these guidelines are more explicit than the Harvard Consensus Report 2006 on which we based our Tell and Repair legal provision. Now these guidelines have to be brougt to practice as soon as possible to the benefit of the present and future victims of medical errors. We sincerely hope that the publication of these guidelines will encourage the medical field to a sense of urgency to implement Tell and Repair as soon as possible as we proposed at the conference of April 23rd 2008 in Utrecht, the Netherlands. See Report Canadian Disclosure Guidelines 2008 (pdf/1.87MB)

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    7. Veterans Health Administration (USA) adopts disclosure and remedial medical care for iatrogenic patients

    October 2005 this department published VHA Directive 2005 – 049 entitled: Disclosure of Adverse Events to Patients

    Institutional disclosure of adverse events must include:
    1. An apology including a complete explanation of the facts
    2. An outline of treatment options.
    3. Arrangements for a second opinion, additional monitoring, expediting clinical consultations, bereavement support, or whatever might be appropriate depending on the adverse event.
    4. Notification that the patient has the option of obtaining outside legal advice for further guidance.
    5. After complete investigation of the facts, the patient or representative is to be given information about compensation under Title 38 United States Code (U.S.C.) Section 1151 and the Federal Tort Claims Act claims processes, including information about procedures available to request compensation and where and how to obtain assistance in filing forms. […]
    6. If a patient or personal representative asks whether an investigation will be conducted and whether the patient or representative will be told of the investigation, the patient or representative is to be informed that only the results of an administrative board of investigation (AIB) may be released.

    This VHA Directive expires October 31, 2010.
    March 2006 the HARVARD HOSPITAL GROUP published its consensus report: When Things Go Wrong: Responding To Adverse Events Massachusetts Coalition for the Prevention of Medical Errors, March 2006 This group clearly chooses for open and honest disclosure as well as providing genuine follow-up diagnostics and remedial medical care to iatrogenic patients. See further under News.
    Apparently and justly the VHA initiative served as an example. May all hospitals follow soon. Go back up