Case Study: Operation CRP - How Confluence Health Launched Their Communication and Resolution Program

Building a communication and resolution program (CRP) from the ground up is a challenge that requires a strategic, coordinated approach. Just ask the team at Confluence Health, an integrated healthcare system in North Central Washington with 270 physicians and 150 advanced-practice clinicians. When its leaders set out to create a CRP in 2016, they sought expert advice, listened to employee input, and tackled tasks one by one. Their efforts launched a robust, well-received program in August 2017 that’s still growing.

Taking a system-wide initiative from concept to initial rollout in six months is a monumental endeavor. But in this case, the task was made manageable by the team’s careful, step-by-step approach. Here, Confluence’s Medical Director of Quality, Randal Moseley, MD; and Risk Manager, Leslie Robinson, CPHRM, share notes about planning, implementing, and growing their CRP.


In February 2016, we attended a workshop hosted by the Collaborative for Accountability and Improvement. That was our first exposure to CRP as a blueprint for how to conduct business. It was career-changing for me. That comprehensive two-day workshop served as a roadmap for everything we subsequently did to revamp our process for response to harm events. The workshop also provided the foundation for BESIDE, our colleague-care program.

We worked with Dr. Thomas Gallagher, executive director of the Collaborative for Accountability and Improvement and Associate Chair of the Department of Medicine at the University of Washington, in the early stages, and we’ve continued to seek input from his group through this process. We also worked with Dr. Tim McDonald, director of the Center for Open and Honest Communication at the MedStar Institute for Quality and Safety. The Washington Patient Safety Coalition and the US Department of Health and Human Services Agency for Healthcare Research and “CANDOR” toolkit ( were also great resources.

—Randal Moseley, MD

“If you don’t have your leadership behind you, I don’t know how you can do this."

Randal Moseley, MD,

Medical Director of Quality, Confluence Health


Soon after, we got our bearings together and approached our leadership team about establishing a CRP at Confluence. We worked with our chief medical officer, our senior leadership team, and ultimately our board. This step is critical. If you don’t have your leadership behind you, I don’t know how you can do this.

Ultimately, it didn’t take much convincing. Right away, we were able to build support for a CRP and begin the process of implementation. We already had a multidisciplinary Culture of Safety Committee, and this initiative tied in with the mission of that group. By involving that group right away, we made this a multidisciplinary project that received input from throughout the organization at the outset. We really felt that to be successful with this, we’d need to start with our culture of safety, so this group was going to be important in helping the initiative move forward.

—Randal Moseley, MD


Determining how we’d measure success was an important piece of this process, and we struggled a bit because we’re still gathering data for our first year. We launched in August 2017, and this August we’ll have a year’s worth of data for evaluation. Right now, we’re looking at total liability costs, requests for records or letters from attorneys, time to closure, and employee retention, and our early feedback is positive.

—Leslie Robinson, CPHRM


Before rolling out a CRP, you need a robust state-of-the-art investigation system for root cause analysis (RCA2) to facilitate greater understanding of how and why an event occurred. So we first established RCA2 based on the model provided by the National Patient Safety Foundation. This led to a key change in the way we handle information gathering after an event. Previously, interviews of those involved took place at the same time in one room. Under RCA2, we conduct one-on-one interviews in a safe environment. We were surprised by how much more effective this was. We get a much broader scope of information, which allows for more accuracy and a faster resolution.

—Randal Moseley, MD


We already had an active burnout prevention program for our physicians, so we knew communication and resolution was a factor in their wellbeing and retention. After we implemented RCA2, we created our colleaguecare program, Bringing Encouragement and Support in Difficult Events (BESIDE). We have a psychologist on staff to meet with providers confidentially after an adverse event to provide support; as far as we know, we’re the only health-care system in Washington to do that. But we’ve found that after an adverse event, people’s first preference is to meet with a peer. Right now we are training eight peer supporters, Confluence employees who can meet with physicians one-on-one after an event to provide support. We’ve had a lot of our providers reaching out to us about this program. I’ve been surprised by the positive impact it’s had already.

—Leslie Robinson, CPHRM

“I think a lot of systems try to do it all at once, and that’s difficult.
We’re focusing on individual pieces, and on getting each one right.”

Leslie Robinson, CPHRM

Risk Manager, Confluence Health


The team’s best advice to other systems just starting CRP initiatives? Make incremental changes, seek feedback, and learn as you go. “I think a lot of systems try to do it all at once, and that’s difficult,” says Robinson. “We’re focusing on individual pieces, and on getting each one right."