Communication Resolution Programs: Reshaping Response to Patient Harm

Despite the best efforts of health care providers and organizations, patients sometimes experience unanticipated and undesirable outcomes in their care. In these cases, open and honest communication with the patient and family is critical to maintaining trust and respect while not compounding patient suffering. In recent years, Communication and Resolution Programs (CRP) have emerged in response to the need for better communication processes in these cases. Locally, the Washington Patient Safety Coalition (WPSC) and partners have launched a statewide Communication Resolution Program and a CRP Certification activity to provide a collaborative forum for adverse event analysis and event response evaluation.

What are Communication and Resolution Programs?

Communication and Resolution Programs (CRPs) are the emerging best practice for addressing patient harm when it happens and preventing it in the future. At the highest level, CRPs provide a systematic approach for openly engaging with patients and moving toward a positive resolution after an adverse event. They increase transparency, allow the care team to express sympathy and regret, and promote fair and reasonable compensation. CRPs contribute to patient safety by ensuring that what’s learned after an adverse event is put into practice. CRPs are characterized by:

• – Transparent and prompt communication
• – Support for involved patients, families, and care providers
• – Rapid investigation and closure of gaps that contributed to the adverse event
• – Proactive resolution
• – Collaboration across all involved stakeholders

What is CRP Certification?

CRP Certification is a process intended to incentivize positive resolutions, learning, and quality improvement after instances of patient harm. When healthcare providers and organizations have utilized a CRP following an adverse event, they can apply for “CRP Certification.” A neutral group of patient safety experts and patient advocates has been convened to review responses to adverse events and certify whether the patient’s needs have been met, any individual or system-level inadequacies have been addressed, and learning has occurred. The certification process provides valuable feedback to healthcare organizations about their CRP processes and demonstrates that they achieved all the essentials of a CRP for a given case.

CRP Certification is an opportunity for statewide learning

With CRP  Certification, we have a new and unique opportunity to share lessons from specific events, which can benefit the entire healthcare community. The CRP Certification team will work to aggregate and disseminate de-identified CRP Certification information to the wider healthcare community so that lessons learned are not confined to the organizations where the events occurred, but can be shared statewide to improve patient safety on a broader scale.  View complete list of CRP Certification benefits 

First Case Analysis/ Lessons Learned: CRP Certification

In July 2017, the CRP Certification Review Panel reviewed their first successfully certified CRP case.  This case involved a medical error that resulted in a patient death. The CRP Certification activity was specifically created to help providers and institutions learn more about the effectiveness of their CRP process with involved patients and providers. To that end, the first case provided the following insights:

• – Prompt ownership and disclosure are crucial: In the certified case, the involved providers were prompt and up front with the patient’s family members. While the care team had not yet determined the full extent of patient harm, this did not deter them from looping in the family immediately and updating them frequently throughout the process.
• – Provider support embeds important safety culture values: The review panel noted that the peer support offered was quick, responsive, and very well done. The relationship between the involved providers and the health care organization was not blame inducing. As a result of this support, the involved provider spearheaded the development of new training processes and materials to prevent event recurrence.
• – Think outside the box in terms of resolution: In cases where an organization deems that a medical error has occurred, there is often an offer to waive bills. In this case, the review panel recognized the organization’s commitment to “make the patient/ family whole” by extending their support in additional ways. The organization handled all travel, lodging, lost wage and other expenses accrued by the patient’s family commensurate to this event.

Additional Resources on CRPs and CRP Certification

• NEWS: The Washington State Hospital Association endorses the Washington CRP
• UPCOMING EVENT: Join us in September for hands on training in CRP implementation at your organization
• SUPPORTING RESEARCH: Michigan Experience
• More about Communication and Resolution Programs in Washington
• More about the CRP Certification activity

Kelly Veit, MHA
Program Director, Washington Patient Safety Coalition

Jennifer Zech, MS
Research Coordinator, UW Medicine Center for Scholarship in Patient Care Quality and Safety