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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 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.


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. Incident reports collected from IRS, patient complaints and retrospective chart review in an academic acute care hospital were classified using the ICPS. In conclusion, 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.

 


The nature and consequences of patient and family emotional harm stemming from preventable medical error, such as losing a loved one or surviving serious medical injury, is poorly understood. Patients and families, clinicians, social scientists, lawyers, and foundation/policy leaders were brought together to establish research priorities for this issue during a one-day conference. They discussed pertinent issues, patient and family experiences after serious harmful events, including profound isolation, psychological distress, damaging aspects of medical culture, health care aversion, and negative effects on communities. The group also created a strategy for overcoming research barriers and actionable “Do Now” approaches to improve the patient and family experience while research is ongoing.


This article discusses the prevalence of disruptive behavior in the healthcare setting, which is defined as any act that influences a group’s intended outcome. Disruptive behavior often takes the form of angry outbursts and passive aggressive actions, especially in extremely stressful environments, such as emergency rooms. This behavior is often detrimental to the culture of safety and quality healthcare, as well as increases the risk of lawsuits. To combat disruptive behavior, five principles are 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

This article explains the challenge of balancing accountability and a “no blame” model in healthcare systems when promoting patient safety. Accountability is defined as taking responsibility for one’s actions. In this article, it is taking responsibility for malpractice that increases patient harm. the “no blame” model is defined as not accusing a single entity for any healthcare misconduct. It is important for healthcare systems to embody both taking responsibility for healthcare malpractices as well as the “no blame” model to effectively promote patient safety and quality and reduce adverse health events.


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

This article explains how healthcare providers and insurers were skeptical of the Agency for Healthcare Research and Quality’s Communication (AHQR) Communication and Optimal Resolution (CANDOR) toolkit, which is a guide for healthcare providers to use if there was patient injury. Healthcare providers and insurers are weary of the CANDOR toolkit, since it does not quickly fix litigation scandals. This toolkit also does not effectively identify patient safety risks. However, the CANDOR toolkit is an effective step for healthcare providers to take in being honest and transparent with their patients about any malpractice or increased risk of injury.


The “Second Victim Rapid Response Team” was a system created to provide psychological, social, and emotional support for healthcare providers who are known”second victims” in the wake of any adverse health outcome or compromise in patient safety.

 


Communication and Resolution Programs (CRPs) investigate and and communicate about events not caused by substandard care. CRPs were quite successful in handling such events, but less consistent in offering compensation in cases involving substandard care.


Operating communication and resolution programs (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 Collaboration Communication-and-Resolution Program (CRP) cut lawsuits by two-thirds and reduced legal expenses and the time needed to resolve claims. Due to this program’s success, physicians are encouraged to integrate CRPs into their health practices to increase overall patient health quality and safety.

 


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

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 Communication and Resolution Program (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 the healthcare setting. These programs are successful, because they promote transparency among patients after an adverse health incident, and increase overall health quality.


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. In this study, CRP participants were interviewed. They identified several factors that contributed to their programs’ success, including the presence of a strong institutional champion and investing in building and marketing the program to skeptical clinicians.


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

Researchers reviewed patterns in healthcare policies and trends in five countries (the United States, the United Kingdom, New Zealand, Australia, and Canada) with histories of disclosing adverse incidents to patients. The researchers wanted to analyze the barriers that prevent healthcare providers and institutions from disclosing adverse events to their patients. They concluded that some barriers included difficulties with liability fees, patients’ beliefs on safety in the healthcare setting, and implementing policy changes on a large-scale. Effective ways to combat these challenges include carrying out a long-term program that involves educating patients and healthcare workers about safety.

 


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

Healthcare providers use root cause analysis to learn from malpractice and decrease the risk of adverse events. This method involves identifying the basic factors that cause performance variability. This model has three parts: 1) what occurred, 2) why did it occur, and 3) what strategies can be used to prevent the event from occurring in the future? This method is effective, because it helps healthcare providers identify the underlying causes of adverse events and take the necessary approaches to combat them.

 

 


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 who created a system in which he followed up with each of his patients years after hospitalization and recorded the end results of their care, including any errors in diagnoses and treatment. Dr. Codman then analyzed these errors and the correlation to patient health outcomes, and used them to make future improvements to not only increase patient safety but to excel as a healthcare provider.


Two victims are involved in adverse incidents within health care. The first victim is the patient and family and the second is the health care provider. Researchers of this study focused on the effects of adverse events on healthcare professionals. They found that it is necessary to develop and implement support systems that can utilized by both patients, families, and healthcare providers when dealing with the effects of adverse incidents.

 


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

The object of this report is 1) to describe how hospitals use incident reporting systems and incident reports, 2) to determine the extent to which hospital incident reporting systems capture patient harm that occurs within hospitals, and 3) to determine the extent to which accrediters review incident reporting systems when assessing hospital compliance with Federal requirements to track instances of patient harm.

 

 


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. To make these programs more successful, legal entities should support them. State and federal policy makers should try to allay potential defendants’ fears of litigation, facilitate patient participation, and address the economic concerns of health care providers.


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, network-like 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.

 

 


The Joint Commission Journal on Quality and Patient Safety (2012) created a toolkit 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.

 

 


The response to adverse events can lack patient-centered-ness, 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.

 

 


Journal Article
Published articles related to CRP
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.

 

 


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 University of Michigan Health System (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. UW Medicine hope that this study will encourage further disclosure efforts, as well as the detailed evaluation of their effects.

 


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.

 


The University of Michigan Health System (UMHS) systematically adopted the “open disclosure with offer” model, a principle-based strategy that emphasizes honesty and disclosure, to effectively respond to adverse patient outcomes and healthcare malpractices. When the UMHS adoped this model, there was a gradual reduction in litigation fees and the number of malpractice and patient harm claims.

 


Communication-and-resolution programs (CRPs) are used by healthcare providers, administrators, and insurers to effectively communicate with and apologize to patients in the wake of adverse incidents; to investigate the occurrence; and offer compensation if appropriate. Researchers examined the effects of CRPs in two community hospitals and two academic medical centers in Massachusetts. They analyzed surveys and recorded data gathered by program members and clinicians at the hospitals. Researchers concluded, that CRPs are effective in increasing patient safety, but there were some barriers in implementing these programs. Barriers included lack of patient participation in disclosing data, as well as some compensation needs not being fulfilled.