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“How to” articles, methods, tools, resources, operations

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.


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.


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.


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.


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.

January 2014


Institution/Organization/Business
Reference to primary CRP related organization (e.g. CAI website)
Tool/Toolkit
CRP resource or tool (e.g. CANDOR)
COPIC Insurance: 3Rs Program – Recognize, Respond, and Resolve

COPIC Insurance Company’s Communication and Resolution program.

From the website:

“When a patient experiences an unexpected medical outcome, they expect honest, open communication and sincere concern from his or her provider about the situation (including an apology when appropriate). In addition, a discussion of the steps that will be taken to prevent reoccurrence of the incident is appropriate in certain situations.

The goals of the 3Rs® Program—to maintain the physician-patient relationship, facilitate open and honest communication and disclosure, and reimburse the patient for related out-of-pocket medical expenses—have remained steadfast throughout the past eleven years.”

COPIC provides medical professional liability insurance.

 


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.

Read more here.


Institution/Organization/Business
Reference to primary CRP related organization (e.g. CAI website)
MACRMI

MACRMI is a Massachusetts alliance of patient advocacy groups, teaching hospitals and their insurers, and statewide provider organizations committed to transparent communication, sincere apologies and fair compensation in cases of avoidable medical harm. We call this approach Communication, Apology, and Resolution (CARe) and we believe it is the right thing to do. It supports learning and improvement and leads to greater patient safety.


Meeting/Conference Proceedings
Meeting/Conference Proceedings
Northwest Communication and Resolution Program Leader Retreat, Sept 2017

Slide decks and agenda for the two day CRP leadership retreat in Seattle, Washington hosted by The Collaborative for Accountability and Improvement and the Foundation for Healthcare Quality.

Program goals:

To present Northwest Hospitals to the CRP concept and introduce local and national resources available to help implement highly functioning CRPs.

To lay the groundwork for an alliance of CRP stakeholders (patients, attorneys, hospital leadership, and health insurers in conjunction with the Foundation for Healthcare Quality) committed to the practice and advancement of CRP in the Northwest.

Takeaways:

Define the core components of a CRP and why each component is critical to a CRP’s effectiveness

Describe the common barriers healthcare organizations experience when implementing a CRP and the strategies for overcoming them

Conduct a CRP gap analysis at their institution and interpret the results

Develop a plan for their organization to implement a CRP effectively


Institution/Organization/Business
Reference to primary CRP related organization (e.g. CAI website)
Oregon Collaborative on Communication and Resolution Programs

The Oregon Patient Safety Commission seeks to advance, support, and encourage patient safety in Oregon. By working to reduce the risk of patient harm and encourage a culture of patient safety through education, shared learning, and improved transparency, we are furthering our vision of safe healthcare for all Oregonians. We are a multi-faceted, semi-independent state agency created by the legislature in 2003 to further patient safety in the state. We operate multiple mission-driven programs, which include the Patient Safety Reporting Program, Early Discussion and Resolution, and various quality improvement initiatives.

See the resource here.


Through communication-and-resolution programs, hospitals and liability insurers communicate with patients when adverse events occur; investigate and explain what happened; and, where appropriate, apologize and proactively offer compensation. Using data recorded by program staff members and from surveys of involved clinicians, we examined case outcomes of a program used by two academic medical centers and two of their community hospitals in Massachusetts in the period 2013–15.


Case Study
Journal Article
Published articles related to CRP
Patients’ Experiences With Communication-and-Resolution Programs After Medical Injury

This interview study of 40 patients, family members, and hospital staff found that patients have a strong need to be heard after medical injury that is often unmet. Although 18 of 30 patient and family participants (60%) reported positive experiences with communication-and-resolution programs overall and continued to receive care at the hospital, they reported that hospitals rarely communicated information about efforts to prevent recurrences.


Institution/Organization/Business
Reference to primary CRP related organization (e.g. CAI website)
Tool/Toolkit
CRP resource or tool (e.g. CANDOR)
Process for Early Assessment, Resolution and Learning (PEARL), Risk Authority Stanford

PEARL – the Process for Early Assessment, Resolution and Learning. A Communication and Resolution program provided by the Risk Authority Stanford.

From the website: “a way to manage unexpected outcomes with honesty, dignity and respect. There is a way to provide the answers that patients and caregivers really need. And there is a way to do this while reducing risk and claim costs.”

About the Risk Authority Stanford: created from the hospital risk management department serving the Stanford University School of Medicine, Stanford Health Care and Stanford Children’s Health. It provides services and solutions to these institutions and health systems, health plans, medical groups and other healthcare and non-healthcare organizations outside of the Stanford family.


The objective of the study was to describe the litigation experience in a state with strict tort reform of a large public university health system that has committed to transparency with patients and families in resolving medical errors.

Read more here.


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.
The Michigan Model: Medical Malpractice and Patient Safety at UMHS

University of Michigan Health System’s approach to medical errors and malpractice claims.

From the website:

“Since 2004, the U-M Health System has been in the national spotlight for its innovative approach to medical errors, mishaps and near-misses — and their potential legal consequences including malpractice suits. We call it the Michigan Model.

You may have heard something about our policy of “saying sorry”, or apologizing and having an open discussion, when clinical care does not go as planned. And while apologies are certainly part of our approach, there’s much more to it than that. Communication, full disclosure, and learning from our experiences are all vital.

You may have also heard that we have steadily reduced the number of malpractice claims pending against us and our doctors, slashed our malpractice expenses, dramatically dropped the amount paid to plaintiffs as a result of judgments or settlements, and cut the time it takes to handle a claim. All of this is true.”


Journal Article
Published articles related to CRP
The University of Michigan’s early disclosure and offer program.

Communication-and-resolution programs: the challenges and lessons learned from six early adopters. Mello MM, Boothman RC, McDonald T, Driver J, Lembitz A, Bouwmeester D, Dunlap B, Gallagher T. Health Aff (Millwood). 2014 Jan;33(1):20-9. doi: 10.1377/hlthaff.2013.0828.


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.
University of Missouri’s ForYou and Caring for the Caregiver

University of Missouri’s forYOU team has been recognized nationally as a leader in supporting their caregivers. They are often contacted by health care providers outside MU Health Care who would like to learn more about their research or use their materials as a model for developing similar programs.


Institution/Organization/Business
Reference to primary CRP related organization (e.g. CAI website)
Washington Foundation for Health Care Quality

The Foundation for Health Care Quality 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.

Read more here.