​Communication-and-resolution programs (CRPs)—which espouse communicating with patients after adverse events occur to explain what happened and, where appropriate, apologize and proactively offer compensation—do not lead to higher liability costs when hospitals adhere to their commitment to offer compensation proactively, according to a study published in the October 2017 issue of Health Affairs. The researchers examined case outcomes of a CRP called CARe (Communication, Apology, and Resolution) used by two Massachusetts medical centers and two of their community hospitals between 2013 and 2015. Under CARe, the hospitals committed to delivering several key elements: an initial disclosure, investigation, referral to insurers when certain criteria were met, and feedback communication that provided the relevant investigation findings and resolution elements. The CARe program's objectives were “to improve communication and transparency surrounding adverse events, improve patient safety, reduce lawsuits and promote reconciliation by proactively meeting injured patients' needs, and support clinicians in disclosing medical injuries." Researchers sought to answer the following questions: Did the institutions adhere to the CRP protocol? If so, did the program lead to high compensation costs? And what did clinicians involved with the program think of it? In answer to the first question, the hospitals demonstrated high adherence to the program. In response to the second, 91% of program events did not meet compensation eligibility criteria, and those that did were not costly to resolve, with a median payment of $75,000. In addition, only 5% of events led to malpractice claims or lawsuits. In response to the third question, although clinicians supported the program, many clinicians were unaware it existed, with one clinician commenting on a survey, “Great idea, too bad it's kept a secret." The authors state that this is likely because risk managers didn't specifically label patient-reported events as “CARe events" when speaking to involved clinicians. Still, the authors state that there must be robust communication with involved clinicians about individual cases to maintain program buy-in.

HRC Recommends: Patients who experience an unanticipated outcome want a representative from the organization to honestly acknowledge it and apologize. Healthcare organizations' policies should clearly identify who will be responsible for disclosure, where and when it will take place, and what will be disclosed. Organization leadership and legal counsel should review their state's laws and consider how a disclosure, apology, and offer model could be implemented. Before such an alternative dispute-resolution plan can be implemented for claims or lawsuits covered by insurance, however, the organization's liability insurer must approve and agree with the process.