When Ascension St. Thomas Hospital Midtown in Nashville, Tenn., disclosed that four patients were harmed in an Aug. 14 safety event, President and CEO Shubhada Jagasia, MD, responded in the first person.
“On behalf of our leadership and care teams, I am deeply sorry for the harm caused to our patients,” she said, as the hospital self-reported the incident to state regulators. The hospital did not share details of the safety event.
The personal, clinical apology stands out. A review of recent apologies from hospital and health system leaders shows most address reputational or administrative missteps rather than patient harm. An even smaller number carry the CEO’s own name.
The recent record skews operational. A North Carolina health system CEO apologized in 2021 for COVID-19 vaccine sign-up problems. Denver Health’s CEO apologized for the timing of executive bonuses in 2020. Baystate Health’s president and CEO apologized in 2025 about an alleged plagiarism episode, and the CEO of St. Peter’s Health in Helena, Mont., apologized in 2023 after nurses’ personal information was leaked. In each case, the executive spoke by name.
Apologies tied to patient harm often follow a different pattern, more often coming from the institution rather than a named leader.
When Cambridge Health Alliance in Massachusetts apologized in 2018 for a patient’s death in 2016, the statement came from the system: “We could have done better, and we will do better.”
A prominent exception is Columbia University Irving Medical Center’s CEO Katrina Armstrong, MD, who said in 2023, “Columbia failed these survivors, and for that we are deeply sorry,” as the center established a $100 million fund for patients abused by former OB-GYN Robert Hadden.
An apology is a ‘bundle,’ not a sentence
A growing body of research helps explain why the wording, the messenger and what comes after all matter. Studies also show why a sentence on its own rarely does the work leaders hope it will.
A scoping review published in June in the Journal of Healthcare Administration synthesized 14 studies across North America, Europe and Australia. Researchers found that patients seldom judge an apology by the apology alone. Effective institutional apologies, the authors concluded, function as a “bundle” — acknowledgement of harm, an explanation of what happened, acceptance of responsibility, repair and sustained follow-up — rather than a single statement. Vague or scripted language tended to read to patients as reputation management, not accountability.
“An apology should never be treated merely as a communications tactic,” said Tessa Misiaszek, PhD, president of leadership and advisory solutions at AMN Healthcare, a healthcare staffing company. “A meaningful apology unfolds over time: The organization owns what happened, explains it, takes responsibility, makes things right and stays in contact afterward.”
Who makes the call
Who decides whether to say any of it publicly is increasingly an institutional call, she said.
“The CEO is ultimately accountable for the organization’s response, but this should rarely be a CEO-only decision,” Dr. Misiaszek said. The strongest decisions, she said, come from a collaboration among clinical and operational leaders, legal counsel, communications, risk management and, when warranted, the board.
Federal policy has started to formalize the shift. Under the CMS Patient Safety Structural Measure, hospitals attest that executives are committed to safety and that a formal communication-and-resolution program is in place, with results reported to the board each quarter, Dr. Misiaszek noted.
The liability math has changed
The instinct that pushes leaders the other way, toward silence, is liability. The evidence complicated that instinct.
Erlanger Health System, a six-hospital system based in Chattanooga, Tenn., adopted a communication-and-resolution program in 2009, requiring staff to be transparent with patients and families after an unexpected harm. Afterward, its external defense costs declined 58% and the number of claims filed in court dropped 42% relative to the rest of Tennessee, according to research published in 2025 in the Journal of Patient Safety and Risk Management. The study found no statistically significant increase in compensation paid.
The program could ease a common fear for physicians. Forty percent of Erlanger’s payment-resolved cases involved a verbal request for money rather than a written demand. The latter triggers a report to the National Practitioner Data Bank. The authors said that pathway could reassure physicians who worry that disclosure and compensation will follow them throughout their careers.
“I do not believe transparency and responsible risk management should be viewed as opposing goals, and the evidence supports that view,” Dr. Misiaszek said. “Hospitals that commit to a complete communication-and-resolution approach have generally not seen their liability exposure grow, and in some cases, legal expenses and time to resolution have declined.”
A policy on paper guarantees nothing
An independent evaluation of Australia’s Statutory Duty of Candour — which legally requires health services to notify patients of a serious harm, apologize and explain what will change — found that how the duty is carried out determines whether it rebuilds trust or compounds the harm.
Among consumers who had experienced an adverse event, half said staff were not open with them afterward, and only 26% were satisfied with the follow-up meeting, according to a study published Aug. 31 in Health Expectations.
Patients who received guarded, procedural responses often described feeling injured a second time.
“For many families, a poorly handled disclosure becomes a second, preventable injury on top of the first,” Dr. Misiaszek said.
What separates the two outcomes appears to be sincerity, not polish. Research by the University of California, Berkeley’s Leanne ten Brinke, PhD, and London Business School’s Gabrielle Adams, PhD, analyzing CEO apology videos, found that leaders who accept responsibility tend to recover faster than those who deflect — and that audiences read authenticity, not production value.
The legal backdrop has also shifted toward openness, if unevenly. More than three dozen states have apology laws to exclude expressions of sympathy as evidence of liability.
Most of these laws protect sympathy rather than admissions of fault, and legal scholars cited in the scoping review found these laws alone do little to change disclosure behavior or ease clinician’s fear of malpractice exposure.
Whether more chief executives follow Dr. Jagasia’s lead may hinge less on the law than on how they weigh two incentives: the reputational value of visible accountability against the long-standing instinct to limit legal exposure. The research points one way. Across the studies, the apologies that rebuilt trust were specific, personal and backed by change. The ones that protected the institution first tended to cost it more — in trust, and sometimes in claims.
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