Until now the healthcare industry only heard anectodal success stories from early adopters of communication-and-resolution programs (CRPs)--models that encourage liability insurers and healthcare systems to disclose unanticipated outcomes to patients and work toward mutual solutions. But a new study published in Health Affairs identifies three factors that contribute to the success of CRPs.
The study analyzed six institutions that implemented CRPs: University of Illinois Medical Center in Chicago, University of Michigan Health System and liability insurers Coverys, COPIC, West Virginia Medical Insurance Company and Stanford University Medical Indemnity and Trust Insurance Company.
Researchers identified three factors for CRP success:
Securing institutional backers: "Participants in all of the CRPs attributed much of their program's success to talented and dedicated institutional champions, who ranged from senior administrators to on-the-ground staff members," wrote lead author Michelle M. Mello of the Harvard School of Public Health. Participants benefited from the support of program founders, clinical leaders and prestigious physicians, whose willingness to put their names to the programs helped them gain legitimacy, according to the study.
Fostering a "culture of transparency:" Success of a CRP hinges on an environment of early reporting and disclosure, according to the study.
Conducting outreach to clinical workers: Participants said it was important during implementation to have administrators make contact with clinicians to fill them in on aspects of the program and who to contact with concerns.
In a separate Health Affairs study, researchers led by Mello analyzed the 2010 implementation of CRPs at five New York City hospitals, finding that while all made improvements in surveillance and disclosure, they had trouble with the compensation aspect of the program. "These experiences suggest that strong support from top leadership at the hospital and insurer levels, and adequate staff resources, are critical for the success of CRPs," Mello wrote.
Meanwhile, a third Health Affairs study examined different types of legislation that help create an environment more receptive to CRPs, including apology protection laws, pre-suit notification laws and provider immunity. "[H]ealthcare providers are a diverse group, and the transition to communication- and-resolution principles and practices may be bumpy," wrote lead author William M. Sage of the University of Texas School of Law in Austin. "Policy makers can help this promising approach succeed by creating a maximally supportive legal and regulatory environment."
A report last year by the Boston Globe found that punitive laws and poor communication are major barriers to transparency in disclosure of errors, FierceHealthcare previously reported.