WEBINAR DATE: May 1, 2020

The COVID-19 pandemic is posing a host of potential medicolegal risks for healthcare providers, institutions, and liability insurers. How should one respond to the patient with behavioral challenges who refuses to comply with social distancing? How do COVID requirements affect consent and surrogate decision-making? What new legal issues are arising with rapid expanding telehealth programs or deploying providers to new care environments such as nursing homes? In what situations should healthcare providers or organizations be provided with immunity for potential adverse events associated with COVID-19 care?

PRESENTERS:

Moderator
Thomas H. Gallagher, University of Washington
Panelists
Marcia Rhodes, University of Washington
Leilani Schweitzer, Stanford Health
Michael Severyn, ProAssurance
Kyle Sweet, Sweet Law Firm

OBJECTIVES:

1. Identify current medicolegal issues associated with COVID-19
2. Consider how medicolegal issues associated with COVID-19 may evolve in the future
3. Discuss possible ways to address these issues

CRPs: Why the insurance industry hasn’t embraced them . . . and why it should presented by Richard Boothman, JD

The driving ideas behind CRPs continue to draw interest and debate, now twenty years after Steve Kraman and Ginny Hamm published their Lexington, KY VA experience with “Extreme Honesty”.  After more than 17 years, the University of Michigan continues to draw attention transparent with their “Michigan Model”, the most successful and longest continual example of a principled, and proactive approach to patients injured in unexpected clinical outcomes.  After years of balking at abandoning “deny and defend” more health systems around the country and around the world are exploring the transition, but a skeptical insurance industry continues to hold back and sometimes, frustrate the desires of their insureds to move in this direction.  Why?  Is the industry’s skepticism well-founded and prudent?  Or is it missing a valuable opportunity?

Rick Boothman, the architect of the “Michigan Model” will initiate a long-deserved discussion into this topic.  His experience suggests that there are multiple insurance advantages in the CRP approach and the insurance industry should rethink old beliefs, practices and prejudices and embrace this model.

Outline

1. Insurance 101 – a dummy’s guide to the construct
2. True CRPs – the essential elements and how the model differs from “deny and defend”
3. What holds the insurance industry back from jumping on board?
4. What is the insurance industry missing and why should it matter?

Learning Objectives

• That too many equate CRPs only with selective, early resolution of potential and asserted claims – what are the essential elements that distinguish a true CRP from established, traditional risk management practices?
• What are the unique outcomes of a CRP and why do they matter?
• Why a CRP better serves the interests of healthcare insureds?
• What unique consequences of a CRP would benefit the insurance industry especially?

Webinar Date: September 17, 2020

Dr. Gordon Schiff talks about diagnostic error and how efforts to reduce diagnostic error align with the principles of communication and resolution programs.

Presenter: Dr. Gordon Schiff (Brigham and Women’s Center for Patient Safety Research and Practice, Harvard Medical School)

Objectives: 

1. Describe the frequency/epidemiology of diagnostic errors based on published studies and surveys.
2. Define diagnosis errors, and using a Venn diagram model differentiate diagnostic process errors, misdiagnosis, and adverse outcomes.
3. List 3 approaches to minimizing and preventing diagnostic errors.
4. Explain ways that missed/under diagnosis and overdiagnosis are related rather than just opposites
5. Describe overlapping and synergistic domains between the diagnostic error/improvement movement andCommunication and Resolution Program (CRP) efforts.

Large Scale Implementation of Communication and Resolution Programs

Presented by: Heather Gocke, M.S., RNC-OB, CPHRM, C-EFM

Webinar Date: January 29, 2020

Ms. Gocke introduces a comprehensive program and a holistic approach in reducing harm in healthcare through large scale implementation of CRP. In her presentation, she highlights the importance of disclosure and engagement, and she shares real-life challenges and secrets to success.

Learning Objectives:

1. Outline the method used to engage member sites in culture transformation
2. Learn  how culture measurement, survey data debriefs, and cognitive interviewing techniques are used to inform this body of work
3. Introduce the five domains and components of BETA HEART

Mitigating the Toll of Medical Errors on Clinicians by Jo Shapiro, MD, FACS

Webinar Date: October 31, 2019

As a clinician, being involved in adverse events can have devastating emotional consequences. How we react to these events – as individuals, colleagues and organizations – has a major effect on our organizational culture of psychological safety, provider wellbeing, disclosure and reporting, and patient safety.  Dr. Shapiro’s presentation will detail these effects and address the unique role that frontline physicians can play in supporting one another after adverse events. She will describe the peer support program developed at Brigham and Women’s Hospital and adopted by dozens of healthcare organizations. She will describe the building blocks of a creating and sustaining a peer support program, including providing the participants with the rationale to bring to leadership in advocating for peer support program resources.

Learning Objectives:

1. Identify the emotional impact of adverse events on clinicians
2. Recognize the impact this has on a culture of psychological safety, provider wellbeing, disclosure and reporting, and patient safety.
3. Provide a rationale to leadership for developing a peer support program
4. Delineate the foundational aspects of a peer support program

Webinar presented by Dr. Tom Gallagher on Thursday, June 6, 2019

Large-scale adverse events, situations in which a breakdown in care has affected multiple (sometimes thousands) of patients, pose significant challenges for institutions related to responding in ways that inform potentially affected patients without unduly alarming them and managing the follow-up. This webinar will highlight lessons learned from the field around responding effectively to adverse events, as well as key unanswered questions.

Learning objectives:

1. Describe the diversity of large-scale adverse events, and how responding to these events differs from managing adverse events that affect individual patients
2. List the key elements of an effective response to a large-scale adverse events and the tools that are currently available to assist with this process
3. Critique an actual large-scale adverse event patient notification letter and press release, and articulate opportunities for improvement in these documents.

WEBINAR DATE: July 16, 2020

This webinar outlines the concerns and questions about the collision between the judicial system and its pathway to addressing medical error and CRP programs.

PRESENTERS: Cindy Jacobs, RN, JD

OBJECTIVES:

1. Describe the basics of how the tort system operates in a medical error/adverse outcome situations
2. Describe the basics and how, when, and why CRP “apology laws,” “mandatory disclosure” laws/requirements, and healthcare licensing systems intersect and/or collide with the tort system
3. Identify key points to assist healthcare professionals in navigating intersections and collisions

Communication-and-resolution programs (CRPs) aim to increase disclosure, learning, and responsibility following adverse medical incidents. The authors of this article identify five obstacles that prevent CRPs from being successful: 1) public policy, 2) compensation for patients following medical errors, 3) application fidelity, 4) evidence of CRPs increasing patient safety, and 5) alignment of CRP methods with patient needs. To increase the success of CRPs, it is recommended that they should be coupled with CRP quality programs. Overall, health institutions are advised to implement these programs into their systems to promote transparency and patient and family engagement.

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.

The Communication and Optimal Resolution (CANDOR) process is a patient-centered approach used by health care institutions and practitioners to respond in a timely, thorough, and just way when unexpected patient harm events occur. It focuses on early disclosure of adverse events and a proactive method to achieving an amicable resolution for the patient/family and health care providers.

The video demonstrates an example of the care team’s disclosure meeting conversation with the affected family.

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.

Discerning complicated approach of ethics and professionalism in medicine can be difficult. It’s similarly challenging when clinicians have to navigate through clinical or relational situation and develop an understanding of ethical, legal and more issues.

The Case Files consist of carefully crafted cases designed to stimulate proper approach and decision-making process. Case 18 focuses on transparent and compassionate disclosure and apology, and recognizing emotional challenged clinicians may face after an adverse event.

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.

The Patient Notification Toolkit was developed to address injection and contagion control malpractice, which occurs in various healthcare settings, such hospitals, and assisted living facilities. These incidents compromise the patients’ health by increasing their risk of infection. When healthcare malpractices or resulting infections are exposed, patients are notified through a detailed process carried out by state and local health departments or healthcare facilities.

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.

This study analyzed if a communication-and-resolution program (CRP) was effective in lowering adverse events among patients with chest pain, as well as lowering medical costs. The study concluded that the implementation of the CRP was efficient, since it helped increase the number of chest pain diagnoses as well as significantly reduced associated health costs.

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.

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.

Colorado Candor Act: ARTICLE 51 Communication and Resolution After an Adverse Health Care Incident (2019)

Physicians are urged to communicate more openly following medical errors, but little is known about pathologists’ attitudes about reporting errors to their institution and disclosing them to patients.The researchers of this article undertook a survey to characterize pathologists’ and laboratory medical directors’ attitudes and experience regarding the communication of errors with hospitals, treating physicians, and affected patients.

The importance of transparent and timely communication with patients following breakdowns in care is widely recognized. This article seeks to gain better understanding of breast cancer care providers’ attitudes regarding communicating with patients about diagnostic errors in order to inform interventions and to improve patient-provider discussions. Discussions focused on providers’ experiences with potential errors in breast cancer diagnosis, communication with patients following three hypothetical diagnostic vignettes, and suggestions for how and why diagnostic errors in breast cancer care should be communicated.
 

The study was conducted gain a better understanding about the attitudes and experiences of breast cancer providers regarding communicating with patients about diagnostic error.

Highlights:

1. Providers more willing to inform patients of a diagnostic error when they felt it would be helpful.
2. Providers willing to inform patients of diagnostic error when feeling responsible for the error.
3. Providers willing to inform patients of diagnostic error if less concerned about litigation.
4. Providers more willing to inform patients of a diagnostic error when the patient asked directly.

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

The Collaborative for Accountability and Improvement Program is currently based at the University of Washington. The goal of the Collaborative is to bring 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. This CRP (Communication and Resolution Program) brochure describes CRP Core Commitments, Key Steps in the CRP Process and Launching a CRP.

This letter to the Editors emphasizes the importance of CRPs in allowing hospitals to learn from all adverse events, even those that may not be traced by loss adjusters, and that the benefits of CRPs exceed their potential to mitigate economic burdens, even during the challenging time of COVID-19.

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?