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 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.

The Agency for Healthcare Research and Quality (AHRQ) is 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.

The Agency for Healthcare Research and Quality (AHQR) developed the CANDOR (Communication and Optimal Resolution) Event Checklist, which is a guide to be used by the CANDOR team after an adverse event occurred in the healthcare setting. The checklist includes effective ways of reporting, assessing, investigating, and analyzing the adverse event to decrease the likelihood of future incidents occurring, as well as improving the overall quality of patient care and safety.

The CANDOR Event Review Report Template is a guide used to analyze and investigate barriers that contributed to an adverse health event. Barriers include poor communication behaviors, unsafe physical environment, inadequate care, and equipment device failure. This template also includes a guide to assess who was responsible for the adverse event, and ways to develop solutions for it so it.

The Communication and Optimal Resolution (CANDOR) process is used  by health care institutions and practitioners to respond in a timely, thorough, and just way when unexpected events cause patient harm. The CANDOR toolkit contains eight different modules, which contain PowerPoint slides with facilitator notes, tools, resources, or videos. Examples of modules include “Care for the Caregiver” and “Organizational Learning and Stability.” These modules focus on effective ways to reduce patient harm and increase overall healthcare quality and safety through family and patient engagement, as well as specific ways to decrease the risk of future adverse outcomes.

Resources for clinicians and staff looking for data and information about the importance of support after adverse medical events, or for administrators that are interested in implementing a peer support program at their institution.

Webinar Date: February, 2021

Overview: COVID-19 has fundamentally altered our care processes and standards.  Care is being delayed, visits are happening by telemedicine, there are changes in how staff are deployed and interact with patients, and everyone is exhausted and emotionally depleted. These all make potential for patient harm events higher.  COVID-19 is also adding stress to already tightening medical professional liability insurance market. While it may be tempting to abandon ship when it comes to implementing CRP during COVID-19 times, CRPs are more important now than ever.  Fundamental principles of the CRP model-supporting patients, families, and clinicians after harm with open communication, empathy, learning, and accountability – are critical elements of how we respond to COVID-related harm events.  This webinar examines two cases of COVID-associated adverse events to help lead a discussion on the challenging aspects in implementing CRPs during this time.

Presenters: Michelle Mello, JD, PhD, and Thomas H. Gallagher, MD

Commentary by: Jeffrey Catalano, JD, Marcia Rhodes, Jonathan Steward, JD, MS, RN-BC, CEN, CPHRM

Learning Objectives: 

• Examine potential communication and legal issues associated with COVID-related harm events
• Describe how CRPs can be used as a strategy to address these COVID-related adverse events
• Learn about CRP resources to help address COVID-related challenges

Webinar Date: September 15, 2022

Presenters: Melinda B. Van Niel, MBA, CPHRM

Melinda B. Van Niel, M.B.A., C.P.H.R.M., has been working to help resolve adverse events through Communication Apology and Resolution (CARe) for ten years. She is the Director of CARe programs at the Betsy Lehman Center for Patient Safety in Massachusetts (formerly MACRMI) leading its implementation team, and consults on CARe implementation for institutions across the country. In the past she worked as the Manager of Patient Safety at Beth Israel Deaconess Medical Center in the department Healthcare Quality where she helped build one of the first CARe programs in the state, and was a contributor and advisor to the AHRQ’s CANDOR Toolkit. Ms. Van Niel received her Bachelor of Arts degree from Harvard University and her Master’s in Business Administration from Villanova University with a concentration in healthcare management.

Webinar Date: September 23, 2021

Presenters: 

• Alan Lembitz, MD, MMM, Chief Medical Officer, COPIC
• Eric Wei, MD, MBA Senior Vice President and Chief Quality Officer, NYC Health + Hospitals
• Laurie C. Drill-Mellum, MD, MPH, Chief Medical Officer, Constellation

Learning Objectives:

• Understand the importance of physician involvement in the CRP process and how it helps both physicians and patients
• Examine the benefits of CRPs to physicians
• Explore the barriers to CRP implementation from a provider’s perspective
• Learn why psychological safety a critical component of provider support

Webinar Date: June 17, 2021

Presenters: Jonathan D. Stewart, JD, MS, RN-BC, CPHRM

Jonathan is a Senior Director of Risk Management and Patient Safety at BETA Healthcare Group, where he serves as a consultant to hospitals, health care facilities and medical groups. His current professional focus includes helping health care organizations operationalize communication and resolution programs, particularly the investigation and analysis of patient harm events.

Objectives:

• Identify conflicting notions of success and failure regarding CRPs
• Discuss the relationship between incomplete CRP implementation and irregular application of CRPs
• Describe lessons learned from unsuccessful applications of CRPs to individual events

Webinar Date: November 17, 2022

Presenters: Lauge Sokol-Hessner, MD, CPPS

Lauge Sokol-Hessner, MD, CPPS is a hospitalist, Clinical Associate Professor of Medicine at the University of Washington, QI Mentor at the UW Medicine Center for Scholarship in Patient Care Quality and Safety, speaker and consultant for the Institute for Healthcare Improvement, and a guest speaker for the Harvard Medical School Masters in Healthcare Quality and Safety (HMS MHQS). He has experience in operational quality & safety, developing leaders in quality & safety, teaching communication skills, coaching health care organizations to implement highly-reliable CRP programs, and he champions patient and family engagement, ethics, humanism, equity, and respect in health care. He completed medical school and residency at the University of Pennsylvania.

Webinar Date: April 15, 2021

Presenters:

• Suz Schrandt, JD,  Senior Patient Engagement Advisor, Society to Improve Diagnosis in Medicine; Founder, CEO, & Chief Patient Advocate at ExPPect
• Eric J. Thomas, MD, MPH Associate Dean for Healthcare Quality, McGovern Medical School, University of Texas Health Science Center at Houston; Board President, Collaborative for Accountability and Improvement

Objectives:

• Understand the individual and system factors that can cause diagnostic errors
• Explore the benefits of a CRP response following a diagnostic error
• Examine the consequences of a poor response to a diagnostic error
• Understand the importance of engaging, listening, and learning from patients and families following diagnostic errors

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

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.

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.

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.

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.

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.

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.

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.

Abstract

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.

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 University of Michigan Health System (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. UW Medicine hope that this study will encourage further disclosure efforts, as well as the detailed evaluation of their effects.

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.

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.

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.

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.