Can I get an “I’m sorry” with a side of accountability?

Health care’s long-overdue transition to using communication and resolution programs when addressing harm

By Molly Craig and Evan Benjamin, MD, MS

For many years, medical professionals were advised not to acknowledge incidents of possible malpractice because this was thought to make the hospital more vulnerable to lawsuits.

Traditionally, the healthcare industry has tended to evaluate medical errors through a “deny and defend” approach. For many years, medical professionals were advised not to acknowledge incidents of possible malpractice because this was thought to make the hospital more vulnerable to lawsuits. Accountability was viewed as an admission of liability, rather than a chance to resolve, learn, and prevent future errors. Consequently, quality and safety of patient care suffered as chances to hide medical error were favored over chances to learn from it.

In instances where providers exhibited greater open communication, patients reported less emotional harm and health care avoidance.

In recognition of these gaps, some hospital systems have implemented Communication and Resolution Programs (CRPs). The intention of these programs is to promote open communication between health care providers and patients and families after adverse events. A CRP calls for early reporting of adverse events; communication to and emotional support for patients, families, and clinicians; transparent learning about the causes of harm; and offers of compensation when substandard care causes patient harm. The core function of a CRP is to increase patient safety and quality of treatment.

By developing a network of system leaders who are supported and empowered in establishing these programs, we can improve the safety and care of both patients and clinicians.

Finally, while PACT’s emphasis is on aligning care with patient goals and preferences to improve the quality of patient care and experience, there is an equally important second focus: to ensure institutional resources are being properly and strategically used for their fullest possible benefits. CRPs are found to lower defense costs and are proven not to increase overall liability costs, so shifting to a consistent use of these practices further fuels the financial incentive.

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