CARe: Resources for administrators

The increased transparency that comes with CARe advances patient safety, improves rapport with patients, and leads to better public relations for the organization. This approach also provides an opportunity to address and heal the emotional impact of errors on health care providers. Additionally, research in Michigan and here in Massachusetts have found evidence of reduced malpractice claims and costs.

Click here for a list of health care organizations in Massachusetts that have committed to the CARe approach.

The following elements contribute to a successful experience with CARe, though it can take time for organizations to build and improve their capacities to:

• Establish a baseline culture of safety focused on continuous improvement and error prevention. Encourage open communication, a just culture, incident reporting and a rigorous root cause analysis system with loop closure/system improvement to prevent recurrences.
• Practice full disclosure and apology in the case of an adverse event. For this to happen, these elements need to be in place:
  • Ability to capture adverse events promptly and reliably
  • Disclosure training for clinicians 
  • Peer support 
  • Mentoring (including just-in-time coaching)
• Ongoing support services for patients, families and providers
  • Click here for more information on clinician and staff peer support, and how to implement a program in your organization.
  • Click here to learn about the Patient and Family Peer Support Network, a free program for Massachusetts residents.

Several studies across the country of facilities that have implemented CARe programs demonstrated that claims either remained flat or decreased with CARe programs in place. Additional studies, such as these published in the New England Journal of Medicine and The Lancet, have shown that patients who pursue litigation often do so because they did not receive clear, empathic, and effective communication after an adverse outcome. Patients and families want to learn the whole story, receive an apology, and have assurances that steps are being taken to prevent similar incidents from happening to other patients. 

Overall costs are likely to go down as well, but with a greater percentage of that compensation going to the patient as opposed to legal costs.

Massachusetts enacted Chapter 224 of the Acts of 2012, aimed at controlling rising health care costs and increasing transparency, efficiency and innovation in the health care system. This law included several provisions to facilitate implementation of the CARe model, which took effect in November 2012.

These provisions included a six-month pre-litigation period, disclosure protections, the sharing of all pertinent medical records, and strong apology protections. Key liability provisions found in the 2012 Massachusetts Payment Reform Legislation are available here.

Yes. If you are interested in learning more about CARe and current initiatives in the Commonwealth, you can contact Melinda Van Niel, Director of Communication and Resolution Programs at the Betsy Lehman Center, at Melinda.VanNiel@BetsyLehmanCenterMA.gov. Members of the CARe Advisory Board, including physicians, attorneys, and risk management professionals, are also available for presentations.