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Surveillance is a fundamental tool of public health. The systematic tracking and analysis of patterns of disease have facilitated innumerable interventions to improve population health, and health officials have worked [...]

Objective. Communication and resolution programs (CRPs) involve institutions responding to adverse events using transparency with patients, event analysis, recurrence prevention, and compensation. Collaboration with regulators around CRPs could enhance health care quality. Setting and Participants. Health care institutions, liability insurers, and the Medical Quality Assurance Commission (MQAC, board of medicine) in Washington State. Study Design. MQAC has collaborated with the Foundation for Health Care Quality (FHCQ) on the CRP Certification pilot. A panel of physicians, risk managers, and patient advocates at FHCQ will review cases for use of the CRP key elements. Cases meeting this standard will be 'CRP Certified.' If MQAC determines that the CRP enhanced patient safety comparable or better than board action, the Commission may close the case. Principal Findings. Developing this process identified the following issues: (1) protecting information submitted for CRP Certification; (2) determining what information the Commission needs to assess whether additional investigation is warranted; (3) preserving the Commission's responsibility to protect the public while working with health care organizations; and (4) addressing concerns that CRP Certification not shield incompetent providers. Conclusions. The CRP Certification program is a promising example of collaboration among institutions, insurers, and regulators to promote patient-centered accountability and learning following adverse events. Key Words. Regulation, legal liability, quality assurance, disclosure, medical errors, From the public's perspective, among the most important entities overseeing the quality of health care are state medical boards. The public acts through elected officials to create state medical boards [...]

Objective. To determine case outcomes in a communication-and-resolution program (CRP) implemented to respond to adverse events in general surgery. Study Setting. Five acute-care hospitals in New York City. Study Design. Following CRP implementation, hospitals recorded information about each CRP event for 22 months. Data Collection Methods. Risk managers prospectively collected data in collaboration with representatives from the hospital's insurer. External researchers administered an online satisfaction survey to clinicians involved in CRP events. Principal Findings. Among 125 CRP cases, disclosure conversations were carried out in 92 percent, explanations were conveyed in 88 percent, and apologies were offered in 72.8 percent. Three quarters of events did not involve substandard care. Compensation offers beyond bill waivers were deemed appropriate in 9 of 30 of cases in which substandard care caused harm and communicated in six such cases. In 44 percent of cases, hospitals identified steps that could be taken to improve safety. Clinicians had low awareness of the workings of the CRP, but high satisfaction with their experiences. Conclusions. The bulk of CRPs' work is in investigating and communicating about events not caused by substandard care. These CRPs were quite successful in handling such events, but less consistent in offering compensation in cases involving substandard care. Key Words. Medical liability, malpractice, patient safety, medical error, In New York State, a volatile liability environment with few tort reforms, there has been keen interest among health care providers in identifying feasible, effective pathways for reducing medical liability [...]

Objective. To implement a communication-and-resolution program (CRP) in a setting in which liability insurers and health care facilities must collaborate to resolve incidents involving a facility and separately insured clinicians. Study Setting. Six hospitals and clinics and a liability insurer in Washington State. Study Design. Sites designed and implemented CRPs and contributed information about cases and operational challenges over 20 months. Data were qualitatively analyzed. Data Collection Methods. Data from interviews with personnel responsible for CRP implementation were triangulated with data on program cases collected by sites and notes recorded during meetings with sites and among project team members. Principal Findings. Sites experienced small victories in resolving particular cases and streamlining some working relationships, but they were unable to successfully implement a collaborative CRP. Barriers included the insurer's distance from the point of care, passive rather than active support from top leaders, coordinating across departments and organizations, workload, nonparticipation by some physicians, and overcoming distrust. Conclusions. Operating CRPs where multiple organizations must collaborate can be highly challenging. Success likely requires several preconditions, including preexisting trust among organizations, active leadership engagement, physicians' commitment to participate, mechanisms for quickly transmitting information to insurers, tolerance for missteps, and clear protocols for joint investigations and resolutions. Key Words. Medical liability, malpractice, patient safety, communication, medical error, Early adopters of communication-and-resolution programs (CRPs), in which health care organizations communicate with patients about adverse events and their causes, use investigation findings to improve patient safety, and they proactively [...]