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Published articles related to CRP

Communication-and-resolution programs (CRPs) are implemented in hospitals to increase patient safety and effective communication between healthcare providers following patient injury. CRPs act as a guide for hospitals to disclose information to patients after medical injury, ways to efficiently investigate the incident, and how to take accountability for the event and offer compensation when appropriate. In this study, the authors analyzed the effectiveness of CRPs in reducing patient harm four Massachusetts health systems. The authors found that CRP implementation were correlated with decreased litigation fees, but they did not alter any other pertinent outcomes, such as reducing patient harm and increasing transparent communication.

 


Abstract

Background Communication-and-resolution programmes (CRP) aim to increase transparency surrounding adverse events, improve patient safety and promote reconciliation by proactively meeting injured patients’ needs. Although early adopters of CRP models reported relatively smooth implementation, other organisations have struggled to achieve the same. However, two Massachusetts hospital systems implementing a CRP demonstrated high fidelity to protocol without raising liability costs.

Study question What factors may account for the Massachusetts hospitals’ ability to implement their CRP successfully?

Setting The CRP was collaboratively designed by two academic medical centres, four of their community hospitals and a multistakeholder coalition.

Data and methods Data were synthesised from (1) key informant interviews around the time of implementation and 2 years later with individuals important to the CRP’s success and (2) notes from 89 teleconferences between hospitals’ CRP implementation teams and study staff to discuss implementation progress. Interview transcripts and teleconference notes were analysed using standard methods of thematic content analysis. A total of 45 individuals participated in interviews (n=24 persons in 38 interviews), teleconferences (n=32) or both (n=11).

Results Participants identified facilitators of the hospitals’ success as: (1) the support of top institutional leaders, (2) heavy investments in educating physicians about the programme, (3) active cultivation of the relationship between hospital risk managers and representatives from the liability insurer, (4) the use of formal decision protocols, (5) effective oversight by full-time project managers, (6) collaborative group implementation, and (7) small institutional size.

Conclusion Although not necessarily causal, several distinctive factors appear to be associated with successful CRP implementation.


Many organizations have struggled to implement CRP models smoothly. The study looks at factors that accounts for the success of two Massachusetts hospital system in implementing a CRP with high conformity to protocol without raising liability costs. Identified factors include: support of top institutional leaders, heavy investments in educating physicians about the programme, active cultivation of the relationship between hospital risk managers.

 


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.


Journal Article
Published articles related to CRP
Error Disclosure and Apology in Radiology: The Case for Further Dialogue

Radiology’s leaders in peer review, patient-centered care, quality and safety, legal affairs, and institutional processes can help prepare radiologists to communicate openly with patients and families about errors by spearheading dialog within the profession regarding how best to implement this emerging practice standard.


Journal Article
Published articles related to CRP
Error Disclosure and Apology in Radiology: The Case for Further Dialogue

Momentum has grown around turning the principle of being transparent with patients about harmful errors into practice. Most radiologists remain profoundly uncomfortable with the prospect of talking with patients about errors. This article describes recent developments driving widespread disclosure and apology efforts in the United States and looks at encouraging radiologists to prepare to discuss errors directly with patients.


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 Agency for Healthcare Research and Quality (AHRQ) published the Communication and Optimal Resolution toolkit, which is a guide for the implementation of communication-and-resolution programs (CRPs). These are holistic and systematic methods for preventing and responding to adverse medical events involving patients. The toolkit also guides on how to promote sincere communication between patients, families and the healthcare team; appropriate financial compensation; and efficient ways to decrease future adverse medical events. The authors describe their personal experiences with applying CRPs in their medical practices in more than 200 hospitals. From their experiences, the authors describe the obstacles that prevented the success of CRP implementation, as well as how they overcame them.


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.

 

 


Communication-and-resolution programs (CRPs) are a systematic response to address adverse medical events, as well as to promote patient safety and healthcare quality. In this study, researchers analyzed the effectiveness of implementing the Communication and Optimal Resolution, a CRP, at MedStar Health, an American community health organization. Researchers found that this program was effective in increasing the number of incident reports, as well as decreased the number of adverse events associated with lawsuits.


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.

 


Researchers of this article studied the long-term impacts (LTIs) of medically adverse events on families and patients years after they occurred. They found that the four main LTIs were 1) prolonged financial effects, 2) continuous anger and vivid recollections of the event, 3) changes in self-identity and health behaviors, and 4) chronic physical effects. The findings of this report emphasize the need for future research focusing on ways to help families and patients dealing with the effects of adverse health events.


Inconsistent CRP implementation and focus on claims savings rather than nurturing a culture of accountability results to missed opportunities for improving quality and safety. The article includes four suggested strategies for implementing and spreading authentic CRPs.


Journal Article
Published articles related to CRP
Legislation/Regulation/Other legislative
Laws relating to CRP
Malpractice Liability and Health Care Quality – A Review

Publish Date: January 28, 2020

A systematic review of 37 studies of malpractice deterrence  published between January 1, 1990, and November 25, 2019 was conducted to examine the association between malpractice liability risk and health care quality and safety. This review found that most studies suggest that higher risk of malpractice liability is not significantly associated with improved health care quality. The findings also suggested that greater tort liability was not associated with the improvement of quality of care.

 

 


Journal Article
Published articles related to CRP
Legislation/Regulation/Other legislative
Laws relating to CRP
Malpractice Liability and Quality of Care: Clear Answer, Remaining Questions

Publish Date: January 28, 2020

This issue presents a thorough and rigorous analysis of recent research and draws findings from 37 studies.  It conclude that increased liability exposure, such as numbers of malpractice claims or changes to state malpractice laws, was not associated with improvement in the quality of patient care.


Researchers studied the factors that encourage and hinder reconciliation after an adverse patient incident occurs. They also discuss recommendations for health systems to follow to approach malpractice legal cases. It was concluded that healthcare organizations should not follow a “one size fits all” approach to all adverse events that compromise patients safety. Rather, they should be flexible when approaching them so they can follow guidelines that promote the best-practice policies for patient safety and exceptional 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.


Communication-and-resolution programs (CRPs) help healthcare providers and insurers effectively communication with patients when  medically adverse event occurs, as well as offer the necessary steps to take to give compensation. Researchers examined the effectiveness of CRP implementation in two Massachusetts hospitals. They concluded that, when the hospitals followed the CRP protocols, there were no drastic increases in liability fees associated with adverse health outcomes. Thus, CRPs helped these hospitals proactively handle adverse incidents and any related litigation fees.


Alberta Health Services (AHS) adopted the Patient and Family Centered Care (PFCC) program to increase patient and family engagement in the healthcare settings. The PFCC encourages and trains patients, families, and healthcare workers to share their experiences and improve care. This program also offers methods to measure the effectiveness of this program.

 


Marx discusses uses a legal viewpoint to discuss how to be more tolerant of errors in the workplace, while also holding people accountable for their mistakes. He outlines four important behavior concepts, and how they can be applied to the healthcare system to decrease risk of adverse events and increase accountability: malpractice, understanding violations, ignorance, and mishaps.


The Medical Event Reporting System for Transfusion Medicine published the “Patient Safety and the ‘Just Culture’: A Primer for Health Care Executives” report, which consists of collected data and analyses on transfusion medicine practices and other related errors. This report also serves as a guide for healthcare administrators, human resource manages, and lawyers to understand current policies and how to successfully implement new investigating and reporting systems that acknowledge human errors and promote overall safety in the workplace.

 

 


Journal Article
Published articles related to CRP
Patients as Partners in Learning from Unexpected Events

Patients and family members identified the factors that contributed to their respective adverse incidents, such as not following safety measures and lack of communication. Participants stated that they were not involved in the analysis process of the adverse events, so they missed out on ways to become more involved in learning about adverse events and how they can be decreased in the healthcare setting. Thus, the authors of this article emphasize that healthcare systems should implement educational modules that not only help decrease the risk of adverse events, but also teach healthcare professionals, patients, and family members on how to be proactive in preventing them.

 


The purpose of this study was to examine the experiences of families and patients with medically adverse incidents, as well as to understand how different healthcare organizations respond to these events. Researchers found that, following adverse events, patient satisfaction was at its peak when communication was compassionate and included discussion of compensation. Satisfaction was also at its highest when physicians attentively listened to patients without interjecting during the conversation.