Advancing Patient Safety with Communication and Resolution Programs
By Felicidad Smith, Communication and Resolution Program Manager at FHCQ
Medical errors, or adverse events that occur unintentionally in healthcare institutions, are more common than the public may realize. Factors such as miscommunication, missed/delayed diagnosis, inadequate monitoring or follow-up, technical errors, and systems failures are some of the common reasons why medical errors persist.1 After an adverse event, what patients want most is an explanation of what happened, an apology, a prevention plan that will guarantee the adverse event will not happen again, and appropriate compensation if the adverse event led to additional medical expenses or disability.2 However, rarely do patients receive any of these things after harm.
Oftentimes, patients and their families are left in the dark after following an adverse event, largely due to facing a “wall of silence” from the hospital and care team. Openly communicating and apologizing to the patient is the right, ethical, and compassionate thing to do. Yet, the fear of litigation and avoiding a medical malpractice lawsuit at all costs places providers in a difficult position. Common messaging providers receive from liability insurers and the hospital’s defense lawyers is to never admit to the error, tell the patient and their family nothing, and to never apologize.3 Reinforcing this, disclosing the error to the patient and family can be an incredibly difficult conversation. Instead of receiving guidance on approaching these conversations from leadership, more often than not, silence is all that patients receive. This approach, coined “deny-and-defend,” has been prominent in healthcare for far too long.4
However, there is a better way to respond to medical errors where patients and their families receive the answers they have a right to know and the care team can apologize without fear of repercussion. Effective support that will benefit all parties impacted by an adverse event will require systematic change away from silence, shame, judgement, and punishment and towards a system that embraces honesty, compassion, and transparency. Most importantly, a healthcare culture that learns from mistakes while also taking every step to ensure that the patient, their family, and the providers feel heard and supported. Communication and Resolution Programs (CRP) has shown to be a powerful solution.
Communication and Resolution Programs
With each passing year, the movement focusing on patient safety and the reduction of preventable harm continues to gain momentum. CRP contributes to this cause by promoting frequent, transparent, empathetic, and accountable communication between patients and their care team after an adverse medical event. The use of CRP plays a pivotal role in leading the paradigm shift of healthcare culture away from denying medical errors and toward a culture that embraces honesty, patient safety, and learning from errors.
The body of evidence highlighting the effectiveness of CRPs continues to grow, showcasing that CRP can reduce lawsuits and lower liability costs over the long term.5 The benefits of CRP has been recognized at the national level, where it has been recommended by the President’s Council of Advisors on Science and Technology for the Center for Medicare and Medicaid Services to make the use of CRP after an adverse event a condition for participation within the next five years.6 With this, it is anticipated that there will be a vast increase in hospitals implementing the CRP model. Patients and their families deserve to know what happened to them after something goes wrong with the care they receive. This shift to embracing transparency after adverse events will be monumental for the advancement of patient safety and systematic quality improvement.
Most healthcare organizations already use some elements of CRP. For example, performing a root cause analysis and providers accessing any form of peer support following a medical error are core elements of CRP. A formal CRP enhances these elements, provides additional guidance on transparent communication with the patient/family, and creates a structured format that prioritizes patient safety.
FHCQ CRP Services
To support organizations with their CRP process or implementation, FHCQ has two free CRP services that aim to improve the quality of care delivery for all participants, CRP Screening and CRP Certification. For both of these services, FHCQ has gathered a group of volunteers who are passionate about patient safety and have years of experience with the CRP model to create the CRP Review Panel. Patient advocates, risk managers, attorneys, physicians, and other healthcare stakeholders are represented in the CRP Review Panel. With their extensive CRP experience, the aim of this group is to support organizations with CRP implementation and process improvement.
With CRP Screening, organizations who are navigating a CRP response can receive support from the CRP Review Panel in real time. CRP Screening is equivalent to receiving expert consulting on an organization’s CRP process. CRP can be complex, especially for organizations who are new to this process. As questions and challenges arise during a CRP response, organizations can come to the CRP Review Panel to receive feedback from experts. This process is intended to provide real-time CRP support, however prior CRP cases can be submitted for CRP Screening as well if the organization would like external advice on how the CRP response could be improved.
CRP Certification is an additional service where the CRP Review Panel evaluates completed CRP responses to determine if the core elements of CRP was satisfactorily met. With this service, FHCQ is proud to partner with the Washington Medical Commission where submitted cases that are “certified” by the CRP Review Panel may be submitted to the Commission as further evidence that patient safety has been met and learning has occurred. In order for a case to be certified by the CRP Review Panel, the applicant must provide a thorough narrative describing how CRP was used during their response to the adverse event. Having an adverse event certified by the CRP Review Panel showcases that the submitting organization has taken initiative in providing transparent and compassionate care to patients while also addressing the system-level gaps that allowed the adverse event to occur in the first place.
Overall, what is required for a CRP to be truly successful is strong organizational leadership and a well-trained care team. What makes CRP difficult is the grander issue of candid transparency and error disclosure. Having these conversations with patients and their families can be extremely difficult, especially if providers are unprepared. By avoiding accountability, many patients are left unsupported and it is a missed opportunity for systematic learning, leaving chance that the error may happen again. Yet, momentum for CRP breaks the age-old practice of deny and defend while promoting a paradigm shift towards an accountable healthcare system. As more hospitals buy-in to the CRP framework, the future of patient safety and quality improvement looks brighter for both patients and providers.
For more information about CRP or FHCQ’s CRP services, contact Felicidad Smith at fsmith@qualityhealth.org or visit qualtyhealth.org/crp.
References
- Medical errors: Honesty is the best policy. (2016, October 3). Harvard Health. https://www.health.harvard.edu/blog/medical-errors-honesty-is-the-best-policy-2016100310405
- Cox, W. (2007). The five a’s: What do patients want after an adverse event¿. Journal of Healthcare Risk Management, 27(3), 25–29. https://doi.org/10.1002/jhrm.5600270306
- Leape, L. L. (2021). A conspiracy of silence: Disclosuredisclosure, apologyapology, and restitution. In L. L. Leape (Ed.), Making Healthcare Safe: The Story of the Patient Safety Movement (pp. 293–317). Springer International Publishing. https://doi.org/10.1007/978-3-030-71123-8_19
- Boothman, R. C. (2016). Candor: The antidote to deny and defend? Health Services Research, 51(Suppl 3), 2487–2490. https://doi.org/10.1111/1475-6773.12626
- Kachalia, A., Sands, K., Niel, M. V., Dodson, S., Roche, S., Novack, V., Yitshak-Sade, M., Folcarelli, P., Benjamin, E. M., Woodward, A. C., & Mello, M. M. (2018). Effects of a communication-and-resolution program on hospitals’ malpractice claims and costs. Health Affairs, 37(11), 1836–1844. https://doi.org/10.1377/hlthaff.2018.0720
- Pcast releases report on transforming patient safety | pcast. (2023, September 7). The White House. https://www.whitehouse.gov/pcast/briefing-room/2023/09/07/pcast-releases-report-on-transforming-patient-safety/