Hospitals nudged to respond better in patient-harm cases

A national center helps healthcare systems embrace an approach to more transparent communications with patients.

FatCamera / Getty ImagesA female patient speaks with a clinician. A national center urges healthcare leaders to more proactively address hospital-based errors.

A misdiagnosis. A medication dosing error. A retained foreign object after surgery. A delay that contributes to a patient’s grave injury or death.   

Adverse effects of medical care can be minor or catastrophic. Large-dollar jury awards have historically led many U.S. hospitals to adopt a deny-and-defend posture. Fearful of lawsuits, a loss of community standing and malpractice insurance cost hikes, administrators often follow legal guidance, directing clinicians to halt contact with a patient or family who may have been harmed by their healthcare. 

The Centers for Medicare & Medicaid Services is encouraging change to that posture. This month, for the first time ever, more than 5,000 accredited U.S. care facilities must attest to whether they have implemented a formal communication and resolution program, or CRP, to manage harm in healthcare with more attention to patients’ well-being. 

“The elements of a communication and resolution program align with what patients expect will happen after something goes wrong in their care: Patients want someone to identify what went wrong and talk with them about it, support them in managing any negative consequences, fix the problem and apologize,” explained Dr. Thomas Gallagher.  

He’s a physician and bioethicist at UW Medicine in Seattle and a longtime advocate for honesty and transparency from hospitals in patient-harm cases. In 2013 he co-founded what is now the Center for Harm Response, an organization created to help U.S. health-system leaders embrace meaningful change in this area.  

The center’s staff provides hospitals with rationale and resources to implement formal CRPs.  

“Most hospitals don't know which harm events need to go through a CRP process. So the center put forth a definition to identify that universe of events and the level of harm,” Gallagher said. “The goal is to get hospitals to not only adopt the model but to apply it consistently when healthcare harms a patient. And then they need to start tracking these events and measuring outcomes and reporting those outcome measures to their boards.” 

Even among hospitals that have implemented a program, he added, “most are flying blind when it comes to how well their CRP is working.”  

Structured, transparent, compassionate responses to harm in healthcare have bottom-line value for hospitals and patients alike. Research shows that hospitals’ liability costs are the same or lower when harm claims are supported by a CRP process, with a greater share of settlements going directly to patients rather than to attorneys. Attorney involvement also is reduced when patients feel their concerns are genuinely heard.  

This data and recent “nuclear malpractice verdicts” of $100 million-plus have hospital executives queuing up for guidance from the Center for Harm Response, Gallagher said. 

“Many of these big-dollar verdicts occur because plaintiff attorneys convince a jury that a big, uncaring, medical entity with deep pockets couldn't be bothered to tell a patient what happened to them and apologize.” 

Organizations that have effective communication and resolution programs are better able to counter such narratives with a jury, Gallagher said. They can show the hospital’s full investigation into the patient’s claim and their record of open communication with the patient and family about the findings. They can take an appropriately conciliatory stance. 

“Some organizations might be satisfied to just check the box attesting they have a CRP in place. But other healthcare systems are embracing this work, really leaning into difficult conversations, to ensure they are supporting not only their patients but also their clinicians. Harm claims have a significant impact on the clinical workforce, and when you feel unsupported by your organization, it makes these cases much worse,” Gallagher said.  

Not every adverse outcome has rationale for a financial payout and apology, he clarified. A patient’s surgical-site infection or allergic reaction to medication isn’t necessarily preventable. Either might occur despite appropriate, competent care.  

“But patients still want an explanation: ‘What happened, and why did it happen to me?’” Gallagher said.