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Published articles related to CRP

The root causes of medical malpractice claims are deeper and closer to home than most in the medical community care to admit. The University of Michigan Health System’s experience suggests that a response by the medical community more directly aimed at what drives patients to call lawyers would more effectively reduce claims, without compromising meritorious defenses. More importantly, honest assessments of medical care give rise to clinical improvements that reduce patient injuries. Using a true case example, this article compares the traditional approach to claims with what is being done at the University of Michigan. The case example illustrates how an honest, principle-driven approach to claims is better for all those involved—the patient, the healthcare providers, the institution, future patients, and even the lawyers.


BACKGROUND:
Incident reporting systems (IRS) are used to identify medical errors in order to learn from mistakes and improve patient safety in hospitals. However, IRS contain only a small fraction of occurring incidents. A more comprehensive overview of medical error in hospitals may be obtained by combining information from multiple sources. The WHO has developed the International Classification for Patient Safety (ICPS) in order to enable comparison of incident reports from different sources and institutions.

METHODS:
The aim of this paper was to provide a more comprehensive overview of medical error in hospitals using a combination of different information sources. Incident reports collected from IRS, patient complaints and retrospective chart review in an academic acute care hospital were classified using the ICPS. The main outcome measures were distribution of incidents over the thirteen categories of the ICPS classifier “Incident type”, described as odds ratios (OR) and proportional similarity indices (PSI).
RESULTS:
A total of 1012 incidents resulted in 1282 classified items. Large differences between data from IRS and patient complaints (PSI = 0.32) and from IRS and retrospective chart review (PSI = 0.31) were mainly attributable to behaviour (OR = 6.08), clinical administration (OR = 5.14), clinical process (OR = 6.73) and resources (OR = 2.06).
CONCLUSIONS:
IRS do not capture all incidents in hospitals and should be combined with complementary information about diagnostic error and delayed treatment from patient complaints and retrospective chart review. Since incidents that are not recorded in IRS do not lead to remedial and preventive action in response to IRS reports, healthcare centres that have access to different incident detection methods should harness information from all sources to improve patient safety.

 


This article begins with a problematic clinical event, then identifies key concepts for dealing effectively with colleagues whose behavior is not consistent with professional standards, group policies or practices. Five principles, reinforced by several action oriented tips and practical tools, are offered as guides to promoting professionalism and professional accountability in support of quality team-oriented care, patient safety and, if necessary, legal defense if disruptive colleagues challenge disciplinary interventions. 


Journal Article
Published articles related to CRP
Balancing “no blame” with accountability in patient safety


Journal Article
Published articles related to CRP
CANDOR: The Antidote to Deny and Defend? Richard C. Boothman


Joint Commission Journal on Quality and Patient Safety, 2010

A unique rapid response system was designed to provide social, psychological, emotional, and professional support for health care providers who are “second victims”–traumatized as a result of their involvement in an unanticipated adverse event, medical error, or patient-related injury.


The bulk of CRPs’ work is in investigating and communicating about events not caused by substandard care. These CRPs were quite successful in handling such events, but less consistent in offering compensation in cases involving substandard care.


Operating CRPs where multiple organizations must collaborate can be highly challenging. Success likely requires several preconditions, including preexisting trust among organizations, active leadership engagement, physicians’ commitment to participate, mechanisms for quickly transmitting information to insurers, tolerance for missteps, and clear protocols for joint investigations and resolutions.


The Journal of Patient Safety and Risk Management published study of an “open” hospital system shows that a “Communication-and-Resolution Program” (CRP) cut lawsuits by two-thirds and reduced legal expenses and the time needed to resolve claims by more than 50 percent compared to before CRP was implemented. Published February 14, 2018

Abstract

Objective: To investigate whether a malpractice reform known as collaborative communication resolution program can improve transparency after an adverse outcome without resulting in higher malpractice liability costs, relative to traditional “deny and defend” approaches.

Methods: Collaborative communication resolution program started at Erlanger Health System in January 2009. We compare liability outcomes before and after collaborative communication resolution program implementation. Annual liability measures evaluated were the number of filed claims, time interval to resolve an event, defense costs, settlement costs, and total liability costs. We describe the process through which events were resolved under collaborative communication resolution program.

Results: One percent of adverse events when there was no medical error received compensation under collaborative communication resolution program; no medical error occurred in 65% of adverse events; 43% of events with injury from medical error were resolved with apology alone. Compared to pre-implementation levels, there was a decrease in the average number of new claims filed (CF) (1.07 to .36, p=.004), defense costs ($41,950 to $20,623 p=.004), settlement costs ($19,480 to $14,228 p=.510), and total liability costs ($61,430 to $34,851, p=.022) under collaborative communication resolution program all measured per 1000 hospital admissions. The median time interval to resolve a claim decreased from 17 months to 8 months, a reduction of 53% (p<.001).

Conclusion: Collaborative communication resolution program implemented at Erlanger had a reduced time interval to resolve events and lower defense and total liability costs. The improved liability outcomes and the total of 43% of events with medical error resolved by apology alone, even though 60% of these patients had legal representation, may encourage physicians to support CRP.


Among patients with chest pain, the implementation of a comprehensive communication-and-resolution program was associated with substantially reduced growth rates in the use of diagnostic testing and imaging services. Further research is needed to establish to what extent these changes were attributable to the program and clinically appropriate.


Journal Article
Published articles related to CRP
Choosing Strategies for Change

The rapid rate of change in the world of management continues to escalate. New government regulations, new products, growth, increased competition, technological developments, and an evolving workforce compel organizations to undertake at least moderate change on a regular basis. Yet few major changes are greeted with open arms by employers and employees; they often result in protracted transitions, deadened morale, emotional upheaval, and the costly dedication of managerial time. Kotter and Schlesinger help calm the chaos by identifying four basic reasons why people resist change and offering various methods for overcoming resistance.


Journal Article
Published articles related to CRP
Web resource/Digital Article
General website that contains CRP related information, may be non-specific or general or mixed resources on a website. Article published on-line. Not available as paper version.
Clinician Support: Five Years of Lessons Learned

Article: Clinician Support: Five Years of Lessons Learned
By Laura E. Hirschinger, RN, MSN; Susan D. Scott, RN, PhD; and Kristin Hahn-Cover, MD

University of Missouri Health Care (MUHC) deployed an evidence-based emotional support structure for second victims based on research with recovering second victims known as the forYOU Team. It was designed to increase awareness of the second victim phenomenon, “normalize” the psychological and physical impacts, provide real-time surveillance for possible second victims within clinical settings, and render immediate peer-to-peer emotional support when a potential second victim is identified. This article describes the forYOU Team experience.


The CRP Certification program is a promising example of collaboration among institutions, insurers, and regulators to promote patient‐centered accountability and learning following adverse events.


In communication-and-resolution programs (CRPs), health systems and liability insurers encourage the disclosure of unanticipated care outcomes to affected patients and proactively seek resolutions, including offering an apology, an explanation, and, where appropriate, reimbursement or compensation. Anecdotal reports from the University of Michigan Health System and other early adopters of CRPs suggest that these programs can substantially reduce liability costs and improve patient safety. But little is known about how these early programs achieved success. We studied six CRPs to identify the major challenges in and lessons learned from implementing these initiatives. The CRP participants we interviewed identified several factors that contributed to their programs’ success, including the presence of a strong institutional champion, investing in building and marketing the program to skeptical clinicians, and making it clear that the results of such transformative change will take time. Many of the early CRP adopters we interviewed expressed support for broader experimentation with these programs even in settings that differ from their own, such as systems that do not own and control their liability insurer, and in states without strong tort reforms.


In communication-and-resolution programs (CRPs), health systems and liability insurers encourage the disclosure of unanticipated care outcomes to affected patients and proactively seek resolutions, including offering an apology, an explanation, and, where appropriate, reimbursement or compensation. Anecdotal reports from the University of Michigan Health System and other early adopters of CRPs suggest that these programs can substantially reduce liability costs and improve patient safety. But little is known about how these early programs achieved success. We studied six CRPs to identify the major challenges in and lessons learned from implementing these initiatives. The CRP participants we interviewed identified several factors that contributed to their programs’ success, including the presence of a strong institutional champion, investing in building and marketing the program to skeptical clinicians, and making it clear that the results of such transformative change will take time. Many of the early CRP adopters we interviewed expressed support for broader experimentation with these programs even in settings that differ from their own, such as systems that do not own and control their liability insurer, and in states without strong tort reforms.

January 2014


Journal Article
Published articles related to CRP
Disclosing Adverse Events to Patients: International Norms and Trends

OBJECTIVES: There is a growing expectation in health systems around the world that patients will be fully informed when adverse events occur. However, current disclosure practices often fall short of this expectation. METHODS: We reviewed trends in policy and practice in 5 countries with extensive experience with adverse event disclosure: the United States, the United Kingdom, Canada, New Zealand, and Australia. RESULTS: We identified 5 themes that reflect key challenges to disclosure: (1) the challenge of putting policy into large-scale practice, (2) the conflict between patient safety theory and patient expectations, (3) the conflict between legal privilege for quality improvement and open disclosure, (4) the challenge of aligning open disclosure with liability compensation, and (5) the challenge of measurement related to disclosure. CONCLUSIONS: Potential solutions include health worker education coupled with incentives to embed policy into practice, better communication about approaches beyond the punitive, legislation that allows both disclosure to patients and quality improvement protection for institutions, apology protection for providers, comprehensive disclosure programs that include patient compensation, delinking of patient compensation from regulatory scrutiny of disclosing physicians, legal and contractual requirements for disclosure, and better measurement of its occurrence and quality. A longer-term solution involves educating the public and health care workers about patient safety.


Journal Article
Published articles related to CRP
Effectiveness and efficiency of root cause analysis in medicine

Root cause analysis has been widely adopted as a central method to learn from mistakes and mitigate hazards. Although there have been some benefits, including increased awareness of faulty processes and fixes to specific problems, there is an undercurrent of sentiment that this approach has limited effectiveness.

 


Journal Article
Published articles related to CRP
Ernest Amory Codman MD: Hero of Patient safety and quality

Ernest Amory Codman MD (1869–1940) was a Boston surgeon. Like all of us, he was human and made mistakes. Unlike others, he made a lifelong systematic effort to follow up each of his patients years after treatment and recorded the end results of their care. He recorded diagnostic and treatment errors and linked these errors to outcome in order to make improvements. Read about how Ernest transformed medicine based on evidence and accountability.

Read more here.


Adverse events within health care settings can lead to two victims. The first victim is the patient and family and the second victim is the involved health care professional. The latter is the focus of this review. The objectives are to determine definitions of this concept, research the prevalence and the impact of the adverse event on the second victim, and the used coping strategies. Therefore a literature research was performed by using a three-step search procedure. A total of 32 research articles and 9 nonresearch articles were identified. The second victim phenomenon was first described by Wu in 2000. In 2009, Scott et al. introduced a detailed definition of second victims. The prevalence of second victims after an adverse event varied from 10.4% up to 43.3%. Common reactions can be emotional, cognitive, and behavioral. The coping strategies used by second victims have an impact on their patients, colleagues, and themselves. After the adverse event, defensive as well as constructive changes have been reported in practice. The second victim phenomenon has a significant impact on clinicians, colleagues, and subsequent patients. Because of this broad impact it is important to offer support for second victims. When an adverse event occurs, it is critical that support networks are in place to protect both the patient and involved health care providers.

September 2012


Journal Article
Published articles related to CRP
Hospital incident reporting systems do not capture most patient harm

The object of this report is to report the following: To describe how hospitals use incident reporting systems and incident reports. To determine the extent to which hospital incident reporting systems capture patient harm that occurs within hospitals. To determine the extent to which accreditors review incident reporting systems when assessing hospital compliance with Federal requirements to track instances of patient harm.

 

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Article from Health Affairs, 2014

Communication-and-resolution programs (CRPs) in health care organizations seek to identify medical injuries promptly; ensure that they are disclosed to patients compassionately; pursue timely resolution through patient engagement, explanation, and, where appropriate, apology and compensation; and use lessons learned to improve patient safety. CRPs have existed for years, but they are being tested in new settings and primed for broad implementation through grants from the Agency for Healthcare Research and Quality. These projects do not require changing laws. However, grantees’ experiences suggest that the path to successful dissemination of CRPs would be smoother if the legal environment supported them. State and federal policy makers should try to allay potential defendants’ fears of litigation (for example, by protecting apologies from use in court), facilitate patient participation (for example, by ensuring access to legal representation), and address the reputational and economic concerns of health care providers (for example, by clarifying practices governing National Practitioner Data Bank reporting and payers’ financial recourse following medical error).


The existing structures and processes that together form an organization’s operating system need an additional element to address the challenges produced by mounting complexity and rapid change. The solution is a second operating system, devoted to the design and implementation of strategy, that uses an agile, networklike structure and a very different set of processes. The new operating system continually assesses the business, the industry, and the organization, and reacts with greater agility, speed, and creativity than the existing one. It complements rather than overburdens the traditional hierarchy, thus freeing the latter to do what it’s optimized to do. It actually makes enterprises easier to run and accelerates strategic change. This is not an “either or” idea. It’s “both and.” I’m proposing two systems that operate in concert.

 

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Joint Commission Journal on Quality and Patient Safety, 2012

A toolkit was developed to help health care organizations implement support programs for clinicians suffering from the emotional impact of errors and adverse events. Based on the best available evidence related to the second victim experience, the toolkit consists of 10 modules, each with a series of specific action steps, references, and exemplars.


Journal Article
Published articles related to CRP
Human error: models and management

The human error problem can be viewed in two ways: the person approach and the system approach. Each has its model of error causation and each model gives rise to quite different philosophies of error management. Understanding these differences has important practical implications for coping with the ever-present risk of mishaps in clinical practice.

 

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The response to adverse events can lack patient-centeredness, perhaps because the involved institutions and other stakeholders misunderstand what patients and families go through after care breakdowns. A PFAC-designed simulation can help stakeholders understand patient and family experiences following adverse events and potentially improve their response to these events.

 

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Leading Change. Why Transformation Efforts Fail

John P. Kotter is renowned for his work on leading organizational change. In 1995, when this article was first published, he had just completed a ten-year study of more than 100 companies that attempted such a transformation. Here he shares the results of his observations, outlining the eight largest errors that can doom these efforts and explaining the general lessons that encourage success.

 

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Journal Article
Published articles related to CRP
Leading Change: Why Transformation Efforts Fail, John P. Kotter

John P. Kotter is renowned for his work on leading organizational change. In 1995, when this article was first published, he had just completed a ten-year study of more than 100 companies that attempted such a transformation. Here he shares the results of his observations, outlining the eight largest errors that can doom these efforts and explaining the general lessons that encourage success.


In an era of calls for greater transparency in health care, disclosure is often cited as a practice necessary to physician ethics and patient safety. The UMHS experience demonstrates that disclosure with offer can be conducted—in a setting similar to many other centers in the United States—without exacerbating liability costs. We hope that this study will encourage further disclosure efforts, as well as the detailed evaluation of their effects.

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Journal Article
Published articles related to CRP
MITSS: Supporting Patients and Families for More than a Decade

This article chronicles the adverse event that catalyzed the formation of Medically Induced Trauma Support Services (MITSS), a non-profit organization with a focus on emotional support in the aftermath of adverse events; the evolution of the organization over the past 11 years; and the development of a menu of support services. By providing a detailed discussion of common themes, shared emotions, long-term consequences, and effective interventions, we hope to inform a greater understanding of the patient/family experience when things go wrong in healthcare.

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In mid-2001 and early 2002, the University of Michigan Health System systematically changed the way it responded to patient injuries and medical malpractice claims. Michigan adopted a proactive, principle-based approach, described as an “open disclosure with offer” model, built on a commitment to honesty and transparency. Implementation was followed by steady reduction in the number of claims and various other metrics, such as elapsed time for processing claims, defense costs, and average settlement amounts. Though the model continues to evolve, it has retained its core components and the culture it nurtured while spurring other initiatives such as a unique approach to peer review. In this article we review our experience, identify the essential practical components of our model, offer suggestions for tailoring the approach to other settings, and present some thoughts as to the future of this approach.

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