Embracing empathy and open communication in pediatrics

By Tim McDonald, Chief Patient Safety and Risk Officer at RLDatix

When something goes wrong in a child’s care, the impact is devastating and deeply personal. For families, it can result in unimaginable grief. For clinicians, it can leave behind an overwhelming sense of guilt and sorrow. Pediatric care is uniquely emotional, children are vulnerable and the stakes feel higher for everyone involved. Yet too often, these moments are met with silence: silence born from fear, shame or a system that lacks support in open and honest communication.

In pediatric care, a persistent culture of silence around medical errors continues to hinder progress, despite the high stakes. This year’s World Patient Safety Day, which focuses on safer care for every child and newborn, highlights the urgent need to improve outcomes for our most vulnerable patients. A more compassionate and transparent approach, which encourages open communication, sincere accountability and systemic learning, is critical to supporting both families and clinicians in the aftermath of adverse pediatric events, where the emotional toll is often profound.

Seventeen years ago, I came to understand this need for transparent communication firsthand while serving as head of patient safety at a hospital. A patient undergoing what should have been a routine procedure to replace a temporary liver stent suffered cardiac arrest due to monitoring failures and ultimately stopped breathing. As a hospital, we failed the patient and their family. As the leader of our patient safety efforts, I took full responsibility for the preventable errors that led to her tragic death.

Rather than retreat behind legal defenses or vague explanations, we were honest. We acknowledged our mistakes and apologized. The family made an extraordinary decision of their own. They joined the hospital’s safety review committee to help ensure that what happened to their daughter would never happen again.

When shame becomes silence

For children and their families, some of life’s most difficult moments unfold within hospital walls. In those moments, the healthcare system must serve as a trusted source of safe, compassionate care. This starts with fostering a culture of safety where clinicians feel empowered to report errors or near misses without fear of retaliation, and where those experiences are recognized as opportunities for learning and improvement. When this happens, it helps prevent harm before it happens, ensures better outcomes and builds a stronger, more transparent system for patients and families who depend on it most.

Unfortunately, the reality is often different. When a child suffers harm, or tragically dies, the weight of guilt for the clinician can be crushing. Without a supportive environment or clear processes to guide these difficult conversations, that guilt can lead to silence. This not only prevents healing for the caregiver but also stalls progress in improving safety for future patients and their families.

Setting clinicians up for success

Empathy and transparency in healthcare are no longer optional, and organizational leadership must take intentional steps to build systems that encourage openness. This is especially true in pediatrics, where clinicians and families face some of the most emotionally charged experiences in medicine.

Hospitals and health systems must ensure that peer support is not just an afterthought, but fully integrated into their operational and technology systems so clinicians have easy, timely access to the resources, guidance and networks they need to navigate emotional situations. Embedding peer support into workflows and digital platforms ensures that providers can seek help when they need it most, encourages a culture of openness and gives clinicians the necessary tools to have open and honest conversations with families.

Supporting families through the hardest conversations

For parents, the loss of a child often brings overwhelming guilt regardless of the circumstances. Thoughtful training equips clinicians to recognize these dynamics, acknowledge the depth of parental grief and approach conversations with the compassion such moments demand.

One effective framework is BETA HEART, developed by the BETA Healthcare Group. These structured questions prepare clinicians for difficult conversations by prompting them to consider important details that might otherwise be overlooked. Do the parents need an interpreter? Are there family dynamics, such as divorced or separated parents, that may shape how the discussion unfolds? What questions are likely to arise and how can clinicians answer them with honesty and clarity?

Most importantly, the framework emphasizes anticipating and validating emotions. Parents experiencing loss may feel anger, despair or guilt — emotions that are entirely natural in the wake of tragedy. The goal is not to minimize these feelings with platitudes, but to acknowledge and validate them, allowing families to grieve in their own way.

Preparing clinicians for these deeply human encounters requires more than theory. Hospitals increasingly rely on role-playing with actors and realistic scenarios. Measures like these, to borrow a phrase coined by a senior director of risk management and patient safety at BETA Healthcare Group, help staff “become comfortable with the uncomfortable.” This kind of preparation empowers providers to enter the most painful conversations with confidence, empathy and the skills needed to support families through their darkest moments.

Building trust for generations to come

When families receive clear, compassionate communication, they find comfort in understanding what happened and gain confidence that steps are being taken to prevent similar events in the future. Without that transparency, many may lose trust in the healthcare system — sometimes carrying that fear for years. Additionally, clinicians who are supported in speaking openly with families are less likely to experience burnout, underscoring the profound impact of these practices.

By fostering a culture of empathy and open communication, healthcare organizations not only protect the well-being of their clinicians but also strengthen the trust of families. In pediatrics, that trust is especially powerful, shaping how future generations experience and engage with the healthcare system.