UW Medicine

UW Medicine is one of the top-rated academic medical systems in the world. With a mission to improve the health of the public, UW Medicine educates the next generation of physicians and scientists, leads one of the world’s largest and most comprehensive biomedical research programs, and provides outstanding care to patients from across the globe.

Communication and Resolution Program (CRP)

The Communication and Resolution Program (CRP) seeks to provide support for patients, families, and involved clinicians following a patient harm event by promoting empathic, transparent and ongoing communication about what happened and what patients and families most need in its wake. Involved clinicians also participate in a peer support program that offers emotional first aid from trained colleagues. How does this build trustworthiness? The CRP helps restore patient and family trust after a “harm event” through a powerful combination of caring, communication and improved reliability/competence.

How It Works

A communication and resolution program (CRP) is a principled, systematic, and comprehensive approach to preventing and responding to patient harm that seeks to meet the needs of patients, families, and clinicians. UW Medicine has implemented a standardized CRP process for our health system that is being pilot tested with high harm events. A CRP response to patient harm includes timely event reporting, robust event investigation, engagement with the patient and family, support for the involved clinicians, and proactive financial and non-financial resolution. A key step in implementation is to define what types of harm events should flow through the CRP process. From there, the organization can map out how a CRP event moves through the process, including the elements listed above, to identify areas where education or process improvements are needed. Because many organizations already have event reporting and investigation processes in place, key areas of focus include a process for ongoing communication with patients and families, emotional support and communication coaching for clinicians, and improved coordination around the transition to claims. To support effective communication with patients and families, clinicians are trained on empathic communication, and communication coaches are identified and trained to provide just-in-time communication coaching. Additional support is given to clinicians through a peer support program that offers emotional first aid from trained colleagues. As the CRP process unfolds, improved coordination between risk management, patient safety and quality, and claims management is crucial, particularly because of its impact on the patient and family’s experience.

Skills and Competencies

The core elements of a communication and resolution program include:

Having a robust culture and climate of safety and quality
Early reporting of adverse events to the healthcare organization
Transparent, empathic, and ongoing communication with the patient and family following a harm event
Peer support and communication coaching for involved clinicians
Robust event analysis using human factors principles
Development and implementation of action plans to prevent recurrences
Proactive and timely financial and non-financial resolution to patients and families

Origins

Despite the best intentions, healthcare does not always go as planned, which can result in harm to patients. The traditional response to patient harm has been to deny and defend in an effort to protect the clinician and organization. However, this can cause further harm to patients and families and can erode trust between patients and clinicians or their organization. A guarded response, without an open dialogue and information about what happened, leaves patients and families without the engagement and information they need and deserve or the support to assist them in moving forward. Maintaining silence can also intensify clinicians’ feelings of guilt, fear, anxiety, and isolation. Finally, a deny-and-defend mindset can get in the way of learning from harm events and preventing future occurrences. The CRP seeks to provide support for patients, families, and involved clinicians following a patient harm event by promoting transparent and ongoing communication about what happened. The CRP encourages collaboration between patients and families, clinicians, risk managers, quality and safety staff, and attorneys, which helps to rebuild trust. Skeptics wondered if this more open approach to harm events would increase clinicians’ and healthcare organizations’ legal liability, but the opposite has proven to be true.

Effectiveness

Research shows that CRPs have a positive impact around many dimensions of trust. There is both quantitative and qualitative data suggesting that CRPs contain the key elements patients and families expect in the response to harm and that they can improve medicolegal expenses and do not worsen them. Qualitative studies have also found that CRPs promote patient and family trust and satisfaction, support clinicians, and enhance quality after harm events. Finally, the literature shows that CRPs drive a healthcare culture of accountability.
CRPs help to rebuild trust between patients and their clinicians and healthcare organization after harm. Disclosing a harm event is the first step in rebuilding trust, but it is just as important to continue communicating with patients and families throughout the process of event investigation and to solicit their view of what happened. Working with harmed patients and families to understand what will make them feel whole during the resolution process is another opportunity to improve the relationship. Finally, identifying and sharing process improvements to prevent recurrences can restore trust in the healthcare system.
It should also be noted that CRPs can promote trust between a clinician and their healthcare organization by fostering a Just Culture and providing support throughout the CRP process.

Scalability

CRPs have proven to be highly scalable. In 2016, the Agency for Healthcare Research and Quality released the CANDOR Toolkit to support the implementation of communication and resolution programs at healthcare organizations across the country. Dr. Gallagher was a key contributor to this Toolkit. In addition, the Collaborative for Accountability and Improvement: A Program of UW Medicine is working to promote CRP adoption nationally. An estimated 400 healthcare organizations are currently in some stage of implementing a CRP. Four states (CO, IA, MA, and OR) have adopted CRP legislation to date.