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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.


Incident reporting systems 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.


Tool/Toolkit
CRP resource or tool (e.g. CANDOR)
A Roadmap for Patients and Families in the Center of Healthcare

The roadmap is a call to action for anyone interested in advancing work related to patient and family engagement. It includes:

  • A vision for patient and family engagement in healthcare.
  • 8 change strategies to drive action towards increased patient and family engagement.
  • 5 simple actions that different stakeholder groups can begin today.

The roadmap unifies actions for patient and family engagement in healthcare, building on decades of evidence, knowledge, and experience. It highlights opportunities to improve our healthcare system by creating meaningful partnerships with patients and families. It is a catalyst, intended to spark ideas and action from individuals and organizations interested in advancing the work of patient and family engagement.


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. 


Institution/Organization/Business
Reference to primary CRP related organization (e.g. CAI website)
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.
Agency for Healthcare Research and Quality (AHRQ)

Agency for Healthcare Research and Quality

The lead Federal agency charged with improving the safety and quality of America’s health care system. AHRQ develops the knowledge, tools, and data needed to improve the health care system and help Americans, health care professionals, and policymakers make informed health decisions.


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.
Agency for Healthcare Research and Quality (AHRQ) Primer: Patient Safety Event Reporting

Overview of adverse event reporting including Background, Characteristics of Incident Reporting Systems, Limitations of Event Reporting, Using Event Reports to Improve Safety, Current Context


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.
Agency for Healthcare Research and Quality (AHRQ): Advances in Patient Safety

Advances in Patient Safety: From Research to Implementation describes what federally funded programs have accomplished in understanding medical errors and implementing programs to improve patient safety over the last 5 years. This compendium is sponsored jointly by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD)-Health Affairs.

The 140 articles in the 4-volume set cover a wide range of research paradigms, clinical settings, and patient populations. Where the research is complete, the findings are presented; where the research is still in process, the articles report on its progress. In addition to articles with a research and methodological focus, the compendium includes articles that address implementation issues or present useful tools and products that can be used to improve patient safety.


Purpose: To provide a checklist for the required actions that need to be taken following an event.


Tool/Toolkit
CRP resource or tool (e.g. CANDOR)
Agency for Healthcare Research and Quality (AHRQ): CANDOR Toolkit

The Communication and Optimal Resolution (CANDOR) process is a process that health care institutions and practitioners can use to respond in a timely, thorough, and just way when unexpected events cause patient harm.

The CANDOR toolkit contains eight different modules, each containing PowerPoint slides with facilitator notes. Some modules also contain tools, resources, or videos.


Video
CRP related video, movie
Annie’s Story

Annie’s story is an example of how healthcare organizations seeking high reliability embrace a just culture in all they do. This includes a system’s approach to analyzing near misses and harm events—looking to analyze events without the knee-jerk blame and shame approach of old.


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


Tool/Toolkit
CRP resource or tool (e.g. CANDOR)
Canadian Patient Safety Institute: Patient Safety Management Toolkit

From the Canadian Patient Safety Institute

Prevent Patient Safety Incidents and Minimize Harm When They Do Occur
When a patient’s safety is compromised, or even if someone just comes close to having an incident, you need to know you are taking the right measures to address it, now and in the future. CPSI provides you with practical strategies and resources to manage incidents effectively and keep your patients safe. This integrated toolkit considers the needs and concerns of patients and their families, and how to properly engage them throughout the process.

Drawn from the best available evidence and expert advice, this newly designed toolkit is for those responsible for managing patient safety, quality improvement, risk management, and staff training in any healthcare setting.


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.


Tool/Toolkit
CRP resource or tool (e.g. CANDOR)
CDC large-scale adverse event (LSAE) patient notification toolkit

A Guide to Assist Health Departments and Healthcare Facilities with Conducting a Patient Notification Following Identification of an Infection Control Lapse or Disease Transmission.

Unsafe injection practices and other lapses in basic infection control put patients at risk of infection. These incidents have occurred in a wide variety of healthcare settings (e.g., hospitals, outpatient clinics, assisted living facilities). When these practices or the resulting infections are discovered, a patient notification process typically ensues. This toolkit is intended to assist state and local health departments or healthcare facilities in conducting a patient notification.


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.


Institution/Organization/Business
Reference to primary CRP related organization (e.g. CAI website)
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.
Communication and Resolution Program Certification (Washington Patient Safety Coalition)

This is the website for the Washington Patient Safety Coalition’s (WPSC) Communication and Resolution Program in the state of Washington.

Of significance is the WPSC’s CRP Certification program. When healthcare providers and organizations have utilized a CRP following an adverse event, they can apply for “CRP Certification.” A neutral group of patient safety experts and patient advocates has been convened to review responses to adverse events and certify whether the patient’s needs have been met, any individual or system-level inadequacies have been addressed, and learning has occurred. The certification process provides valuable feedback to healthcare organizations and demonstrates that they achieved all the essentials of a CRP.

The Washington Patient Safety Coalition is a program of the Foundation for Health Care Quality (The Foundation). The Foundation is a nonprofit organization dedicated to providing a trusted, independent, third party resource to all participants in the health care community – including patients, providers, payers, employers, government agencies, and public health professionals.


A CRP brochure from the Collaborative for Accountability and Improvement describing: CRP Core Commitments, Key Steps in the CRP Process and Launching a CRP. A very good paper to begin an understanding of CRP.

The Collaborative for Accountability and Improvement brings together leading experts to support the growth and spread of Communication and Resolution Programs (CRPs), advocate on behalf of these programs with a shared voice, and exchange ideas. CRPs drive quality improvement, enhance patient safety, and facilitate patient-centered accountability.

The Collaborative, which is currently based at the University of Washington, is poised to bring these programs to scale in the US and beyond

 


Videos from The Risk Authority, Stanford in partnership with Aon, Lockton UK, MedPro Group and SorryWorks!

Communication and Resolution Programs (CRPs) promise to reduce liability costs, promote a culture of safety and provide a vehicle for disclosure and healing between providers and patients after a medical error. Over the past decade, several CRPs have been pioneered and studied at leading medical centers.

In this live webcast event, we brought together three leading voices in the field – a health law scholar, a physician and a patient, to discuss:

Topics will include:

Have CRPs delievered on their promise?
What do the data show?
What best practices have emerged?
What challenges need to be overcome?
What resources are available to institutions interested in exploring or strengthening CRPs?


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


Case Study
Institution/Organization/Business
Reference to primary CRP related organization (e.g. CAI website)
Tool/Toolkit
CRP resource or tool (e.g. CANDOR)
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.
Comprehensive Unit-based Safety Program (CUSP)

The Comprehensive Unit-based Safety Program (CUSP) was created by Johns Hopkins patient safety researchers and brought to the public domain through the Agency for Healthcare Research and Quality (AHRQ). CUSP aims to improve patient safety culture while providing frontline caregivers with the tools and support that they need to tackle the hazards that threaten their patients.

The AHRQ toolkit includes training tools to make care safer by improving the foundation of how your physicians, nurses, and other clinical team members work together. It builds the capacity to address safety issues by combining clinical best practices and the science of safety.

It is noteworthy that between 2009 and 2011 the “On the CUSP: Stop BSI [Blood Stream Infections]” succeeded in reducing CLABSIs [Central Line Blood Stream Infections] nationwide. States reduced their adult ICU rate from a baseline of 1.915 infections per 1,000 line days to a rate of 1.133 infections, or a relative reduction of 41 percent. (https://www.ahrq.gov/professionals/quality-patient-safety/cusp/clabsi-final/clabsifinal3.html)