Our Expertise

Intensive Skill-Building for Difficult Conversations

Based at Boston Children’s Hospital and Harvard Medical School, The Institute for Professionalism and Ethical Practice enhances clinical communication in health care in ways that benefit patients, families, and the hospitals, clinical teams, and clinicians who care for them.

We combine education and training with empirical research on best practices. Offering consultation worldwide, IPEP is highly-regarded for its expertise in how to plan for and engage in difficult conversations.

Institutions, teams and clinicians can tap into IPEP’s expertise by enrolling in workshops, requesting a customized program to bring IPEP into their institution, or--new in Fall 2019--training their trainers to bring IPEP-developed insight to their teams. 

The Most Difficult Conversations in Healthcare

Ideally, all patient news is promising. When it’s not, a clinician must discuss very difficult medical topics, such as a poor prognosis, an upsetting test result, or end-of-life choices. These complex conversations can take a toll on everyone involved. For empathetic and caring clinicians, the cumulative effect of many such conversations, day in, day out, can lead to emotional exhaustion and burnout.

The recent report A Crisis in Healthcare: A Call to Action on Physician Burnout, from the Massachusetts Medical Society and other leading organizations notes that "meaningful steps to address the (burnout) crisis and its root causes must be taken at a systemic and institutional level." Better mental healthcare for clinicians is necessary—and starts with team-wide skills and readiness for the practical and emotional toll of difficult situations.

IPEP offers training and counsel in how to plan for and hold the most difficult conversations in healthcare, with attention to values and ‘everyday ethics’, professionalism, and interprofessional teamwork, collaboration and practice, as well as clinician and patient well-being.

See upcoming IPEP Difficult Conversations Workshops 

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The role of a disclosure coach

Disclosure and apology after medical error or adverse events:

Interdisciplinary and Specialty-Specific

Speaking with patients or their families after a medical error or an adverse medical event is one of the most difficult and emotionally challenging conversations any clinician can have. Handling it well is critical for the patient’s experience, the clinician’s own resilience, and the hospital, too. IPEP trains clinicians how to hold such a conversation with good preparation, presence and compassion. We also train trainers who wish to bring this skill back to their own institution, and coach clinical leaders so they can coach members of their team when needed.

As Dr. Sigall Bell, IPEP's Director of Patient Safety and Quality Initiatives, states, "It is important to remember that communication after harmful events is a process, not an isolated event." IPEP training covers:

  • Planning for disclosure
  • Re-establishing trust
  • Managing distress (including the kind of distress on your own team that can lead to burnout)
  • Coaching colleagues

IPEP offers D&A training via:

  • Interdisciplinary workshops 
  • Specialty-specific workshops, such as Disclosure & Apology in Radiology >

Best practice

The Best Response to Medical Errors? Transparency

The Association of American Colleges reports on why an open approach to medical errors benefits not only patients and their families, but also medical students, physicians, and teaching hospitals.


"This workshop takes the fear out of handling difficult conversations with patients. The accompanying video and PDF resources are also invaluable."

~ Gloria Hwang, MD

Director of Clinical Performance Improvement,

Stanford University Department of Radiology

See upcoming IPEP Disclosure & Apology Workshops >

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Facilitated Peer Support and Group Dynamics, especially in Nursing

Amid the urgency of care, it’s essential to sustain and strengthen the caregivers. But what can be done? Some institutions prioritize personal coping tools and mental health services, while others explore better ways to interact with electronic health records. Leadership matters, so many healthcare organizations have appointed chief wellness officers to explore solutions from the top. At the forefront of promising solutions is an approach blending individual resilience and structural change with the buy-in to make it stick: staff-driven peer support.

IPEP facilitates staff-driven peer support through its monthly PERCS Rounds, which invite clinical staff to share difficult or challenging experiences with each other in a supportive environment and to learn practical and helpful tools for their everyday practice. As implemented in several Boston Children’s Hospital critical care units since 2010, with collaboration and support from the hospital’s Critical Care Nursing leadership, IPEP psychosocial and family faculty guide each session, alongside nursing unit champions and leaders and ethics experts. PERCS Rounds topics typically cover real-time issues surrounding moral resiliency, difficult conversations with patients and team members, ethical dilemmas, patient safety, patient-family experience, and self-care.With an opportunity to share experiences and process difficult moments together, staff come away feeling more supported, less alone, and with useful strategies for the future. 

IPEP offers implements PERCS Rounds:

  • Monthly at Boston Children’s Hospital
  • By training in Boston and trains teams worldwide to establish hospital-specific PERCS Rounds in their own institutions.
  • NEW! Online, available worldwide

Best practice

A recent cover story in Critical Care Nurse, “Navigating Communication Challenges in Clinical Practice: A New Approach to Team Education,” explores six years of PERCS data and concludes that this structural peer support approach is feasible and effective. Nursing staff have particularly embraced the PERCS Rounds approach. Of the 1,100 participants in the last six years, 56% have been nurses. Social workers (9%), child life specialists (9%), and others (16%) such as chaplains, technicians, and interpreters have also attended. Read more > (link to upcoming blog post)

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Aligning Patient-Provider Expectations for Informed Consent

Asking patients and families for their informed consent often means requesting approval of a surgery, procedure, or course of treatment they have had little time or training to understand. Good communication for informed consent is vital for patients, families, and providers. When communication is inadequate, it can lead to frustration or misunderstandings. The pre-operative encounter represents a particular challenge for surgeons, who often have limited time to establish relationships and trust with patients and families.

Teams and clinicians can learn better ways to approach the informed consent process. With our self-paced online course, IPEP training offers skills and strategies to increase clarity and alignment of expectations among patients, families, and providers—all online, for clinicians to access at their convenience. The course offers special attention to the issues of surgical informed consent.

Register for the Online, Self-Paced Informed Consent Course >

Request Consultation, Training, or a Speaker >

Palliative Care Conversations Across the Spectrum of Care

Improving the quality of life for neurologically complex patients and their families requires specialized communication skills and a capacity to build solid, long-standing relationships. This training is especially appropriate for those in critical care, neonatology, neurology, neurosurgery, and anesthesiology.

IPEP’s palliative care course was inspired and designed based on the needs for improved interdisciplinary and inter-subspecialty communication identified by the family of Paul Contini, a former patient at Boston Children’s Hospital. We bring together clinicians and team leaders from across disciplines for day-long learning that builds skills and understanding. Participants engage in realistic enactments with professional actors—as patient and parent ethical understudies—and then watch videotapes for feedback, debriefing, and group discussion. We encourage participants to reflect on their personal and professional experience, using real-life experiences to help them rethink and improve their approach to difficult conversations with patients and families.

See upcoming Palliative Care Workshops >

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