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.
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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.
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 CRPLegislation/Regulation/Other legislative
Laws relating to CRPOrganizational Policy
Organizational, institutional policyHow U.S. Teams advanced communication and resolution program adoption at local, state and national levels
Published articles related to CRP
Laws relating to CRP
Organizational, institutional policy
This article explains the methods used by nine teams in their efforts to get hospitals to implement CRP, state legislators to pass state laws to encourage CRP adoption by hospitals, and national medical societies to endorse CRP to their members. It also identify reasons for the successes, failures, and obstacles faced by the teams in their effort to advance CRP.
Journal Article
Published articles related to CRPImplementing communication and resolution programs: Lessons learned from the first 200 hospitals
Published articles related to CRP
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.
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.Institute for Healthcare Improvement (IHI) and the National Patient Safety Foundation (NPSF)
Reference to primary CRP related organization (e.g. CAI website)
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 Institute for Healthcare Improvement (IHI) and the National Patient Safety Foundation (NPSF) started collaborating together to utilize its combined resources and knowledge to further patient safety efforts and create safety systems in various healthcare settings.
Legislation/Regulation/Other legislative
Laws relating to CRPIowa Candor Statute
Laws relating to CRP
Iowa’s Candor Statute – Iowa Code §135P (2017)
Institution/Organization/Business
Reference to primary CRP related organization (e.g. CAI website)MACRMI
Reference to primary CRP related organization (e.g. CAI website)
The Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI) created the Communication, Apology, and Resolution (CARe) Approach. This strategy aims to further patient safety by fostering honest communication, apologies, and just compensation in adverse situations. MACRMI partners with patient advocacy organizations to to teach health insurers and hospitals about this strategy.
Journal Article
Published articles related to CRPMaking communication and resolution programmes mission critical in healthcare organisations
Published articles related to CRP
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 CRPLegislation/Regulation/Other legislative
Laws relating to CRPMalpractice Liability and Health Care Quality – A Review
Published articles related to CRP
Laws relating to CRP
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 CRPLegislation/Regulation/Other legislative
Laws relating to CRPMalpractice Liability and Quality of Care: Clear Answer, Remaining Questions
Published articles related to CRP
Laws relating to CRP
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.
Legislation/Regulation/Other legislative
Laws relating to CRPMassachusetts Payment Reform Legislation
Laws relating to CRP
MA 2012 Payment Reform Legislation (Ch 224) – Key Liability Provisions
Meeting/Conference Proceedings
Meeting/Conference ProceedingsNorthwest Communication and Resolution Program Leader Retreat, Sept 2017
Meeting/Conference Proceedings
The Collaborative for Accountability and Improvement and the Foundation for Healthcare Quality hosted a two-day retreat in Seattle, Washington (09/2017) in which administrators and healthcare providers discussed ways to advance communication and resolution programs (CRPs) and other resources in Northwest Hospitals to increase patient safety and communication among hospital leadership, attorneys, and health insurers.
Institution/Organization/Business
Reference to primary CRP related organization (e.g. CAI website)Oregon Collaborative on Communication and Resolution Programs
Reference to primary CRP related organization (e.g. CAI website)
The Oregon Patient Safety Commission (OCCRP) seeks to advance, support, and encourage patient safety through education, shared learning, and improved transparency in Oregon. It is a multi-faceted, semi-independent state agency created by the state legislature to further patient safety in the state. The OCCRP operates multiple mission-driven programs, which include the Patient Safety Reporting Program, Early Discussion and Resolution, and various quality improvement initiatives.
Legislation/Regulation/Other legislative
Laws relating to CRPOregon Resolution of Adverse Health Care Incidents Act
Laws relating to CRP
Oregon Resolution of Adverse Health Care Incidents Act (2013)
Case Study
Journal Article
Published articles related to CRPOutcomes In Two Massachusetts Hospital Systems Give Reason For Optimism About Communication-And-Resolution Programs
Published articles related to CRP
Journal Article
Published articles related to CRPOutcomes In Two Massachusetts Hospital Systems Give Reason For Optimism About Communication-And-Resolution Programs
Published articles related to CRP
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.
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
Reference to primary CRP related organization (e.g. CAI website)
CRP resource or tool (e.g. CANDOR)
The Risk Authority Stanford is a healthcare risk management organization established at Stanford University School of Medicine, Stanford Children’s Health, and Stanford Health Care. This organization developed the Process for Early Assessment, Resolution and Learning (PEARL), a communication-and-resolution program (CRP) aimed to approach unexpected adverse incidents with respect and honesty, which also decreasing litigation fees and overall risk. The Risk Authority also offers solutions and services to medical organizations and healthcare systems outside of Stanford.
Journal Article
Published articles related to CRPResolving Malpractice Claims after Tort Reform: Experience in a Self‐Insured Texas Public Academic Health System
Published articles related to CRP
The authors of this study analyzed the importance of healthcare professionals being transparent in medical malpractices with their patients in the Texas healthcare system. The authors found that medical mishap litigation helped significantly reduce suing and other damages. The authors also emphasized the importance for healthcare systems to work with attorneys, policy makers, and patients to help develop methods to be more transparent about medical mishaps and enforce proactive mediation.
Audio
Audio recording, Podcast, etc.RTE Radio 1 Interview with Jo Shapiro
Audio recording, Podcast, etc.
Dr. Jo Shapiro of Brigham and Women’s Hospital is interviewed about disclosure, peer support, and resilience following medical error on Ireland’s national public radio, RTÉ Radio 1 (July 9, 2017).
In April 2012, Glenn Clarkson died after a medical error at a rural Kansas hospital. Melissa and Nancy Clarkson describe the three-and-a-half-years of work it took for them to learn what happened in his medical care. Filmed at the Communication and Resolution Program (CRP) Training.
Institution/Organization/Business
Reference to primary CRP related organization (e.g. CAI website)The Collaborative for Accountability and Improvement
Reference to primary CRP related organization (e.g. CAI website)
The Collaborative for Accountability and Improvement is a network based at the University of Washington, Seattle, composed of the physicians, attorneys, and insurers who pioneered the earliest CRPs in the United States. It is our belief that communication-and-resolution programs (CRPs) are an essential strategy for preventing medical errors and cultivating high-quality, patient-centered healthcare. Our mission is to radically accelerate the adoption of CRPs nationally and internationally, particularly through education, training, and hands-on support.
Book/Report
Reference to book or report
The field guide to understanding ‘human error’
Reference to book or report
In The Field Guide to Understanding ‘Human Error,’ Sidney Dekker discusses how organizations can successfully deal with perceived “human error” without implementing new rules, punishing people, or requesting compliance. Dekker discusses how people embody “the Bad Apple Theory,” which states that an institution would be safe and reliable albeit a few irresponsible individuals in it. To combat this theory and “human error,” Dekker encourages organizations to learn to understand mistakes, how to improve investigative processes, and how to increase the safety climate of the workplace. He does this by offering specific strategies that encourage organizations and employees to think creatively to foster a safe environment that mitigates “human error.”
Book/Report
Reference to book or report
The Financial and Human Cost of Medical Error… and How Massachusetts Can Lead the Way on Patient Safety
Reference to book or report
This report from the Betsy Lehman Center details two sets of research findings and proposes a coordinated response through which Massachusetts’s providers, policymakers, and public can accelerate safety and quality improvement and lead the nation on this urgent health care challenge.
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
Reference to primary CRP related organization (e.g. CAI website)
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 Michigan Health System developed the Michigan Model. This approach involves reducing and acknowledging medical errors through open communication between the patient and health institution, peer-reviewing the complaints to analyze the cause of the adverse event and how to prevent it in the future, and meeting with the patient and legal counsel to discuss the adverse event. With these implementations, the University of Michigan Health System successfully helped reduce the number of malpractice accusation against physicians, medical error fees, and total time it takes to manage a malpractice claim. Thus, the University of Michigan Health System is a leading innovator in increasing patient care and safety while also decreasing the adverse outcomes associated with medical malpractices.
Video
CRP related video, movieThe Story of Michael Skolnik – YouTube Video
CRP related video, movie
The Medstar’s Patient Safety and Quality Program included this video in their patient safety and care program. This video illustrates the story of Michael Skolnik, who lost his life due to medical malpractice. The error involved the surgeon not being completely transparent with the patient or his family about the surgical procedure. This video emphasizes the importance of shared decision making between patients, families, and physicians to avoid future adverse medical outcomes, especially ones in which lives are lost.
Journal Article
Published articles related to CRPThe “Seven Pillars” response to patient safety incidents: Effects on medical liability processes and outcomes
Published articles related to CRP
The objective of this study was to determine whether a communication-and-resolution program (CRP) to adverse patient events is correlated with changed in medical litigation actions and outcomes. Researchers found that the implementation of a communication and optimal resolution (CANDOR) program was most successful. These programs consist of methods for effectively identifying an event, investigation, resolution, and care for healthcare providers. The CANDOR program was correlated with long-lasting fiscal and clinical improvements. It also helped increase incident report rates, as well as decrease the number of litigation and malpractice claims and fees.
Journal Article
Published articles related to CRPThe “Seven Pillars” Response to Patient Safety Incidents: Effects on Medical Liability Processes and Outcomes
Published articles related to CRP
The purpose of this study was to determine whether a communication and optimal resolution (CANDOR) program was effective in reducing the number of health liability processes and associated adverse outcomes. Researchers found that this program helped significantly increase the number of incident reports received, as well as decreased the litigation, settlement, and self-insurance fees associated with medical malpractices and adverse events.
Journal Article
Published articles related to CRPThird Things as Inspiration and Artifact: A Multi-Stakeholder Qualitative Approach to Understand Patient and Family Emotions after Harmful Events
Published articles related to CRP
Patient and family emotional harm after medical errors may be profound. At an Agency for Healthcare Research and Quality (AHRQ) conference to establish a research agenda on this topic, the authors used visual images as a gateway to personal reflections among diverse stakeholders. Themes identified included chaos and turmoil, profound isolation, organizational denial, moral injury and betrayal, negative effects on families and communities, importance of relational skills, and healing effects of human connection. The exercise invited storytelling, enabled psychological safety, and fostered further collaborative discussion. The authors discuss implications for quality/safety, educational innovation, and qualitative research.
Tool/Toolkit
CRP resource or tool (e.g. CANDOR)TJC Framework for Conducting a Root Cause Analysis and Action Plan
CRP resource or tool (e.g. CANDOR)
The Joint Commission’s Framework for Root Cause Analysis (RCA) and Action Plan offers a holistic outline of questions used for healthcare organizations to analyze adverse events in the workplace. Questions include identifying specific protocols in the procedure, external factors, staffing numbers, and other factors that could have potentially influenced the adverse outcome.
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.TJC Patient Safety Systems Chapter, Sentinel Event Policy and RCA2
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 Joint Commission published three reports that address patient care and reducing risks of adverse health outcomes: the Patient Safety Systems , Sentinel Event Policy, and RCA2. The Patient Safety Systems report explains how healthcare professionals can develop effective measures to promote patient safety and compassion towards coworkers. The Sentinel Event Policy report details how the Joint Commission collaborates with healthcare institutions to promote patient safety and improve systems that reduce the risk of adverse incidents. The RCA2: Improving Root Cause Analyses and Actions to Prevent Harm report illustrates strategies that institutions or individuals can utilize to analyze the hazards and faults in their systems to they can effectively prevent future adverse medical outcomes.