In 2010, five hospitals in New York City implemented a communication-and-resolution program (CRP) in general surgery. Its intent was to improve the nature of hospital discussions of medical errors with patients.
The primary program goals were to improve reporting of serious adverse events to risk management and support clinical staff in discussing these events with patients. The results of the CRP over a 22-month period, recently published in Health Affairs, showed fairly positive results.
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“The New York hospitals that implemented CRPs made big strides in their communication with families following adverse events and in the amount of monitoring and follow-up they did when an unexpected event occurred," said report author Michelle Mello, professor of law and public health in the Department of Health Policy and Management at the Harvard School of Public Health. “They perceived that they really improved the culture surrounding disclosure of medical errors."
Other goals of the CRP included rapidly investigating why injuries occurred, communicating to patients what was discovered, and offering apologies and compensation when the standard of care was not met.
"Part of the improved monitoring [the hospitals] did involved identifying cases where a clear error caused serious harm and the family was complaining about the care," Mello explained. "In these cases, they moved more rapidly to resolve the incident by offering appropriate compensation.”
On the other hand, Mello explained that the “hospitals struggled more with the idea of offering compensation in cases where a lawsuit didn't seem to be looming." To some institutional leaders, that idea was a "tough sell,” she said.
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“It's more difficult to operate a CRP when you have a risk-averse institution and a risky liability environment like New York's,” Mello noted. She said the CRP component involving proactive compensation offers whenever an error causes serious harm was particularly challenging for the hospitals.
According to Mello, the experiences of the New York hospitals show that it takes strong leadership support, an institutional champion, and a commitment of extra resources of to succeed in implementing CRPs.
Mello believes the lessons learned by these five facilities should help other institutions better understand whether or not they have the appropriate level of resources and leadership to move forward with a similar CRP program.
“Although the New York hospitals encountered challenges in implementing some aspects of the communication-and-resolution process, the message they had for others was, ‘Do it!’” Mello affirmed.
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