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Brochure
Marketing information or simple papers, flyersCommunication and Resolution Programs (CRPs): What Are They and What Do They Require?
Marketing information or simple papers, flyers
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.
Journal Article
Published articles related to CRPCommunication and Resolution Programs in the COVID-19 Era: A Unique Opportunity to Enhance Patient Safety (and Save Money)
Published articles related to 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.
Journal Article
Published articles related to CRPCommunication-and-resolution programs: the challenges and lessons learned from six early adopters
Published articles related to CRP
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 CRPCommunication-and-resolution programs: The jury is still out
Published articles related to CRP
This article explains how communication-and-resolution programs (CRPs) are successful in decreasing litigation fees and compensation that results from patient harm. However, the success of CRPs depends on patient satisfaction, making it necessary for healthcare professionals to focus on factors that increase this. Even though there is little evidence to support the idea that CRPs reduce adverse medical events that result in patient harm, these programs do have the potential to do so.
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)
Reference to primary CRP related organization (e.g. CAI website)
CRP resource or tool (e.g. CANDOR)
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 Comprehensive Unit-based Safety Program (CUSP) was created by Johns Hopkins University 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 front line caregivers with the tools and support that they need to tackle the hazards that threaten their patients. This program has been used to target a wide range of problems, such as patient falls, hospital-acquired infections, and medication administration errors.
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.
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
Reference to primary CRP related organization (e.g. CAI website)
CRP resource or tool (e.g. CANDOR)
COPIC is an insurance company that covers medical liability expenses. The company developed the 3Rs (Recognize, Respond, and Resolve) Program to prevent adverse events and increase patient safety. The goals of the 3Rs Program are 1) to maintain a healthy and professional relationship between the physician and patient, 2) foster honest conversation, and 3) reimburse the patient for pertinent medical fees.
Tool/Toolkit
CRP resource or tool (e.g. CANDOR)COVID-19 Consent for Treatment/Procedure/Surgery Form
CRP resource or tool (e.g. CANDOR)
The Sweet Law Firm in Oklahoma City, one of the Collaborative for Accountability and Improvement’s partners in promoting the spread of CRPs, has developed a COVID-19 Consent for Treatment/Procedure/Surgery form.
Tool/Toolkit
CRP resource or tool (e.g. CANDOR)COVID-19 Ready Communication Skills – VitalTalk Tips
CRP resource or tool (e.g. CANDOR)
VitalTalk has released the COVID Ready Communication Skills resource to help healthcare professionals navigate COVID-19 related conversations with their patients and families.
VitalTalk is a Seattle based nonprofit organization that provides resources and training for health care clinicians in effective communication.
Book/Report
Reference to book or report
Organizational Policy
Organizational, institutional policyCrisis Standards of Care
Reference to book or report
Organizational, institutional policy
Crisis Standards of Care (CSC) was developed in 2009 by the Institute of Medicine in response to consecutive catastrophic disasters happening around the world. The report provides a framework for a systems approach to the development and implementation of CSC plan that should apply in disaster or crisis situations. It was designed to help state and local public health officials and health-sector agencies and institutions operationalize CSC.
Institute of Medicine; Board on Health Sciences Policy; Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations; Dan Hanfling, Bruce M. Altevogt, Kristin Viswanathan, and Lawrence O. Gostin, Editors
Journal Article
Published articles related to CRPDisclosing Adverse Events to Patients: International Norms and Trends
Published articles related to CRP
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 CRPDisclosing Harmful Mammography Errors to Patients
Published articles related to CRP
Greater openness with patients about harmful errors is recommended. Many ethicists and professional organizations endorse disclosure of harmful errors to patients.The Joint Commission’s accreditation standards now require that patients be informed about unanticipated outcomes. In response, many hospitals are developing disclosure programs. Yet, recent studies suggest that disclosure of harmful medical errors to patients is the exception
rather than the rule. This article explores radiologists’ attitudes about disclosing errors to patients by using a survey with a vignette involving an error interpreting a patient’s mammogram, leading to a delayed cancer diagnosis.
Journal Article
Published articles related to CRPDisclosing Harmful Pathology Errors to Patients
Published articles related to CRP
Medical errors are unfortunately common. In the United States, Institute of Medicine proposed a set of guidelines for mitigating and disclosing errors. In order to implement these recommendations in pathology, it will require a better understanding of how errors occur in pathology, the relationship between pathologists and treating clinicians in reducing error, and pathologists’ experiences with and attitudes toward disclosure of medical error.This article aims to understand pathologists’ attitudes toward disclosing pathology error to treating clinicians and patients.
Journal Article
Published articles related to CRPTool/Toolkit
CRP resource or tool (e.g. CANDOR)Disclosure Coaching: An Ask-Tell-Ask Model to Support Clinicians in Disclosure Conversations
Published articles related to CRP
CRP resource or tool (e.g. CANDOR)
Despite the obvious need for open conversations with patients and their families following an adverse event, many organizations still lack the structure to support providers during this difficult time. In many cases, clinicians who have to disclose errors to patients and families fail due to lack of provider education and training, lack of confidence, fears of litigation and emotional distress.
The Ask-Tell-Ask Model focuses on successful disclosure coaching conversations. It includes:
- Case Scenario
- Key elements
- Practical step-by-step strategies for disclosure coaching
- Pedagogical model using the “Ask-Tell-Ask” approach
- Organizational considerations for establishing a coaching program
Video
CRP related video, movieDisclosure of Delayed Diagnosis of Breast Cancer
CRP related video, movie
This video focuses on principles and skills for effective disclosure conversations, especially around delayed cancer diagnosis, and includes a case example.
Learning Community
Resources associated with CAI Learning CommunityVideo
CRP related video, movieDISCLOSURE TO FAMILY — WISDOM IN MEDICINE, PATH THROUGH ADVERSITY
Resources associated with CAI Learning Community
CRP related video, movie
A short video of Dr. Shapiro speaking on disclosure of medical error to patients and families. This video is part of “Choosing Wisdom: The Path Through Adversity” documentary.
Journal Article
Published articles related to CRPDisclosure-And-Resolution Programs That Include Generous Compensation Offers May Prompt A Complex Patient Response
Published articles related to CRP
This article dissects the meaning of “disclosure-and-resolution” programs, which call health organizations to disclose medical errors to patients and families involved; apologize; and offer compensation when necessary. Health systems that used approach found decreased litigation fees. Researchers analyzed surveys in which individuals used “disclosure-and-resolution programs where appropriate. They found that increasing compensation allowances following an adverse event did not improve results, nor did it decrease the likelihood of patients and families filing lawsuits following an adverse event. Thus, it is important for healthcare systems to remember that “disclosure-and-resolution” programs may help promote effective and honest communication between patients and families, but it does not decrease associated legal costs or the possibility of a lawsuit.
Tool/Toolkit
CRP resource or tool (e.g. CANDOR)Early Discussion & Resolution (EDR) Conversation Guidance
CRP resource or tool (e.g. CANDOR)
Early Discussion & Resolution (EDR) Conversation Guidance from Oregon Patient Safety Commission offers general guidance that can serve as a foundation in initiating conversations and follow ups.
An adverse event can gravely affect both patients and their families and providers. Having a conversation between healthcare providers and patients about the incident can bring resolution and closure.
Goals of EDR from Oregon Patient Safety Commission:
- Prevent an unfortunate situation from escalating
- Restore the keystone of healthcare—the provider-patient relationship
- Bring greater peace of mind to everyone
- Learn from events to improve patient safety
Journal Article
Published articles related to CRPEffectiveness and efficiency of root cause analysis in medicine
Published articles related to CRP
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 CRPEffects Of A Communication-And-Resolution Program On Hospitals’ Malpractice Claims And Costs
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.
Journal Article
Published articles related to CRPEnsuring successful implementation of communication-and-resolution programmes
Published articles related to CRP
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 CRPEnsuring successful implementation of communication-and-resolution programmes
Published articles related to CRP
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.
Journal Article
Published articles related to CRPErnest Amory Codman MD: Hero of Patient safety and quality
Published articles related to CRP
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 CRPError Disclosure and Apology in Radiology: The Case for Further Dialogue
Published articles related to CRP
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 CRPError Disclosure and Apology in Radiology: The Case for Further Dialogue
Published articles related to CRP
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.
Learning Community
Resources associated with CAI Learning CommunityVideo
CRP related video, movieFDNH 3: Disclosure of Medical Error
Resources associated with CAI Learning Community
CRP related video, movie
The video includes three scenarios to demonstrate how different approaches to disclosure can have an effect on the course of communication with a patient’s loved one.
Disclosure Scenarios:
- Disclosure with No Apology
- Disclosure with Apology of Sympathy
- Disclosure with Apology or Responsibility
This guide for Getting Started with a CRP Policy or Commitment Statement outlines key elements and suggestions for developing an institutional CRP policy or commitment statement. It was developed by members of CAI’s Policy Committee in partnership with patient and family advocates.
Book/Report
Reference to book or report
Handbook of human factors and ergonomics in health care and patient safety
Reference to book or report
The Handbook of Human Factors and Ergonomics in Health Care and Patient Safety offers a detailed overview of ergonomics and and human factors, theories, methods, and models that are pertinent to patient care and safety. Specific topics included in this book include telemedicine, infection prevention, and anesthesia safety.
Journal Article
Published articles related to CRPHealth care professionals as second victims after adverse events: a systematic review
Published articles related to CRP
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 CRPHow Policy Makers Can Smooth The Way For Communication-And-Resolution Programs, Health Affairs
Published articles related to CRP
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.
Journal Article
Published articles related to CRPHow the most innovative companies capitalize on today’s rapid-fire strategic challenges-and still make their numbers
Published articles related to CRP
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.