Healthcare organizations, liability insurers, and clinicians consistently follow the CRP core principals when they use a CRP successfully to respond when patients are harmed in the course of their medical care. In well-implemented CRPs, all elements of the eight CRP essentials are present.

The 8 CRP core commitments include:

1. Immediately report adverse events to the healthcare institution.
2. Communicate with patients about what happened, whether it was preventable, why it happened, and how recurrences will be prevented.
3. Analyze adverse events using human factors principles and develop action plans to prevent recurrences.
4. Support the emotional needs of the patient, family and care team.
5. Proactively and promptly offer financial and non-financial resolution to patients and families when care is unreasonable.
6. Educate patients and families about their right to seek legal representation at any time.
7. Work collaboratively with involved healthcare organizations and professional liability insurers to resolve adverse events.
8. Assess the effectiveness of the CRP using tested and accepted measures.

Key steps in the CRP process

Outlined below are the key steps of the CRP process. There are four main sections of the CRP process: Initial Response, Patient Safety and Quality Improvement Activities, Continued Patient Engagement and Movement Towards Resolution, and Post-Event Dissemination of Patient Safety and Quality Improvement Lessons Learned.

Initial Response

1. Immediately report the adverse event to the institution or organization.
2. Ensure the patient’s immediate clinical needs related to the risk or adverse event are addressed.
3. Ensure the immediate needs of the involved clinicians are addressed, as it is common for clinicians involved in an event that harmed a patient to experience acute distress.
4. Engage the patient and family as soon as possible after the event’s discovery in establishing priorities and expectations. This includes listening to and communicating with the patient and family about what happened, how the patient’s immediate needs are being addressed, what the patient should expect from the CRP process going forward, and unqualified expressions of empathy.
5. Monitor and respond to the patient’s and family’s needs, questions and concerns and share factual (as differentiated from speculative) information about the event as it becomes available.
6. Hold the patient’s bills, pending outcome of the event analysis.

Patient Safety and Quality Improvement Activities

1. Undertake a rigorous, human-factors-based event analysis that incorporates information and perspectives
   from the patient and family.
2. Develop and implement plans for preventing recurrences of the event, based on human factors and Just
   Culture principles.

Continued Patient Engagement and Movement Toward Resolution

1. Hold a resolution discussion with the patient and family and share the final results of the event analysis and prevention plans.
2. Proactively offer fair financial and non-financial resolution to the patient and family for adverse events determined to be caused by unreasonable care, rather than waiting for the patient and family to request compensation.
3. Educate patients or their families about their right to seek legal representation at any time.

Post-Event Dissemination of Patient Safety and Quality Improvement Lessons Learned

1. Summarize the lessons learned with identifying information removed and disseminate throughout the organization.
2. Take steps to ensure wide distribution of lessons learned so other clinicians and institutions can prevent the same kinds of mistakes. Share with other healthcare institutions, professional associations, and stakeholder groups

A comprehensive CRP essentials document created by the Collaborative for Accountability and Improvement can be found here.