Until recently, when hospitals and physicians made errors when dealing with patients, the hospital risk managers and insurers generally recommended "defend and deny" policies.

A growing number of health care providers are adopting "disclosure and apology" policies for dealing with patients who have experienced a medical error. Several states have passed laws protecting doctors' apologies from being used at trial, and more hospitals are implementing policies requiring that doctors and nurses quickly reveal errors to patients and families when warranted.

The stance of risk managers and insurers has changed in part because of mounting evidence that disclosure and apology programs, which often include an upfront offer of a financial settlement, can sharply reduce malpractice costs.