Communication and resolution programs are the emerging best practice for more effectively addressing patient harm and preventing it in the future. As CRPs gain traction nationwide, several standout states share what’s working.
OREGON: TWO-WAY COMMUNICATION
Oregon was one of the first states in the country to pass a law (Oregon Laws 2013, Chap. 5) promoting open, transparent communication between health-care providers and patients and families across all health-care settings—what is now Oregon’s Early Discussion and Resolution (EDR) program. The EDR program, which is voluntary, offers support and legal protections for these important communications. EDR communications between patients and providers are protected by state law. Oregon remains the only state to allow both patients and health-care providers to initiate these types of conversations; similar programs in other states only allow provider initiation. The EDR statute also covers a very broad range of providers, from podiatrists to dentists to pharmacists. The Oregon Patient Safety Commission collects de-identified data through a voluntary survey after EDR communications have concluded. Over time, OSPC will be able to use this rich data set to offer guidance to providers on how to more effectively address and resolve adverse events across Oregon.
Beth Kaye, Director, Early Discussion and Resolution Program, Oregon Patient Safety Commission
MICHIGAN: INTEGRATED IMPROVEMENTS
In the old-school risk-management model of “deny and defend,” communication often halts, and everyone goes to his or her separate corner, the moment a patient gets hurt. Providers are forced to abandon their clinical mission and stay silent until the deposition. There are strict walls between hospitals’ quality-and-safety and risk-management groups. In 2001, I suggested three foundational principles to guide our response to injured patients and improve communication and resolution, and one was that we learn from all patient experiences, good and bad. Our priority is the patient we haven’t hurt yet: how do we improve and keep a given adverse event rom happening again? Many organizations are trying to proactively get in front of patient injuries, but too often they are largely reactive instead, and very few seem to understand that our driving fundamental aim is keeping preventable injuries from happening in the first place. The beauty of this approach is that it has fueled all sorts of good things that were frustrated in “deny and defend.” We’ve seen the broad growth of evidence-based peer review, improvements in informed consent, and other clinical improvements not likely in a defensive culture, while the number of patient claims has fallen by over two-thirds.
Richard Boothman, JD, Chief Risk Officer, University of Michigan Health System
MASSACHUSETTS: EVIDENCE-BASED CHANGE
When I started, we wanted to provide a better alternative than litigation for resolving adverse outcomes. Massachusetts was the first to do this as a statewide initiative instead of as a closed system. To facilitate this, we negotiated and enacted enabling legislation in 2012, which established a six-month pre-litigation resolution period, appropriate protections for apology, the requirement to share all pertinent medical records, and the obligation to disclose significant adverse events. We learned that many patients don’t want compensation—they want open, honest communication, a sincere apology for avoidable injury, and an assurance of what’s being done to prevent any recurrence. Research shows us that apology is extremely important for patients in dealing with their anger, and for providers in dealing with their grief. Ultimately, this approach is about taking responsibility for our adverse outcomes, and doing what is morally and ethically right for patients, providers, and the health-care system as a whole. It allows our providers to practice evidence-based medicine, not defensive medicine, and to focus on health-care safety, ultimately saving lives.
Alan Woodward, MD, Emergency Physician and Chair, Committee on Professional Liability, Massachusetts Medical Society
Important collaboration has been taking place for several years with regulators in Washington, including the CRP Certification program developed in collaboration with the Medical Quality Assurance Commission. The CRP Certification program allows institutions and physicians who have used a CRP in responding to an adverse event to submit an application describing how the event was handled to a neutral expert-review panel based at the Foundation for Health Care Quality.
The benefits of participating in CRP Certification are widespread. The key benefits of CRP Certification for each unique stakeholder group are listed in the table below.
Additional information about the CRP Certification process can be found on the Foundation for Health Care Quality’s website at www.crp.qualityhealth.org.