Michelle Mello and colleagues: Effects Of A Communication-And-Resolution Program On Hospitals' Malpractice Claims And Costs. (Bottom line: "...transparency, apology, and proactive compensation can be pursued without adverse financial consequences.")

Health Aff (Millwood). 2018 Nov;37(11):1836-1844. doi: 10.1377/hlthaff.2018.0720.

Effects Of A Communication-And-Resolution Program On Hospitals' Malpractice Claims And Costs.

Kachalia A1, Sands K2, Niel MV3, Dodson S4, Roche S5, Novack V6, Yitshak-Sade M7, Folcarelli P8, Benjamin EM9, Woodward AC10, Mello MM11.

Author information

1

Allen Kachalia ( akachalia@bwh.harvard.edu ) is chief quality officer at Brigham Health, in Boston, Massachusetts.

2

Kenneth Sands is chief epidemiologist and chief patient safety officer at HCA Healthcare, in Nashville, Tennessee.

3

Melinda Van Niel is a project manager at Beth Israel Deaconess Medical Center for the Massachusetts Alliance for Communication and Resolution following Medical Injury, in Boston.

4

Suzanne Dodson, now retired, was project manager at Baystate Health, in Springfield, Massachusetts.

5

Stephanie Roche is a health care quality research analyst at Beth Israel Deaconess Medical Center.

6

Victor Novack is head of the Clinical Research Center at Soroka University Medical Center and a professor of medicine at the Faculty of Health Sciences, Ben-Gurion University of the Negev, in Beer Sheva, Israel.

7

Maayan Yitshak-Sade is a postdoctoral research fellow at the Harvard T. H. Chan School of Public Health, in Boston.

8

Patricia Folcarelli is vice president of health care quality at Beth Israel Deaconess Medical Center.

9

Evan M. Benjamin is chief medical officer of Ariadne Labs, Harvard T. H. Chan School of Public Health and Brigham and Women's Hospital.

10

Alan C. Woodward, an emergency medicine physician in Concord, Massachusetts, is past president and former chair of the Committee on Professional Liability of the Massachusetts Medical Society.

11

Michelle M. Mello is a professor of law at Stanford Law School and a professor of health research and policy at Stanford University School of Medicine, in California.

Abstract

To promote communication with patients after medical injuries and improve patient safety, numerous hospitals have implemented communication-and-resolution programs (CRPs). Through these programs, hospitals communicate transparently with patients after adverse events; investigate what happened and offer an explanation; and, when warranted, apologize, take responsibility, and proactively offer compensation. Despite growing consensus that CRPs are the right thing to do, concerns over liability risks remain. We evaluated the liability effects of CRP implementation at four Massachusetts hospitals by examining before-and-after trends in claims volume, cost, and time to resolution and comparing them to trends among nonimplementing peer institutions. CRP implementation was associated with improved trends in the rate of new claims and legal defense costs at some hospitals, but it did not significantly alter trends in other outcomes. None of the hospitals experienced worsening liability trends after CRP implementation, which suggests that transparency, apology, and proactive compensation can be pursued without adverse financial consequences.