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Information for patients from the Agency for Healthcare Research and Quality (AHRQ) |
For patients and families |
Sample template for Massachusetts sites required to send response letters to patients who have experienced a Serious Reportable Event (SRE)
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CARe toolkit |
Sample template for Massachusetts sites required to send response letters to patients who have experienced a Serious Reportable Event (SRE)
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CARe toolkit |
Comparing the traditional approach to claims with an honest, principle-driven approach at the University of Michigan using a true case study |
Research and data |
Pocket card for clinicians listing steps to take after an adverse event and who to contact for help talking to patients |
CARe toolkit |
Chart describing initial steps of CARe process after a significant adverse event occurs |
Implementation guides |
Chart describing CARe process for insurers after internal investigation finds standard of care wasn't met and the patient was significantly harmed |
Implementation guides |
Article in the New England Journal of Medicine describing barriers to physician accountability and suggests penalties for failure to adhere to patient safety practices |
Research and data |
Guidance for lawyers representing health care providers during CARe process |
Best practices • For attorneys |
How lawyers can best support patients during the CARe process |
Best practices • For attorneys |
Best practices to ensure patients have appropriate legal representation during conversations regarding resolution and compensation |
Best practices |
Ten recommendations for running a CARe program.
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Best practices |
Guidance for insurers involved in the CARe process |
Best practices |
Ensuring a patient-centered approach during the CARe process |
Best practices |
Report prepared by the Harvard Negotiation and Mediation Clinical Program about how to best represent patients participating in CARe |
Best practices • Research and data |
Overview of the CARe process, from the initial patient safety alert to resolution meetings and offers of financial compensation |
Implementation guides |
Study of how physicians disclose errors to patients, and recommendation of standards to promote professional responsibility following errors |
For clinicians • Research and data |
Flow chart with examples of what to say and what not to say during conversations with patients and families |
For clinicians |
Study by the New South Wales Department of Health that aims to improve the experience of staff, patients, and caregivers |
Research and data |
Sample data in Excel, from a multi-specialty medical group |
Research and data |
Michelle Mello, J.D., Ph.D., and Lena Kuznetsov, M.A., present CARe data from Beth Israel Deaconess Medical Center, Boston Medical Center, Brigham and Women's and Brigham-Faulkner |
Research and data |
Summary of defensive medicine and possible remedies, from the Massachusetts Medical Society
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Research and data |
Findings underscore the need for organizations to adopt a team disclosure process that includes nurses |
Best practices • For clinicians |
Paper in the Suffolk University Law Review that emphasizes the importance of legal representation for patients in disclosure and offer programs |
Best practices |
Presentation by Jeffrey Driver, J.D., M.B.A. and Shirley Johnson, R.N., M.B.A., on the PEARL program at Stanford Health Care |
Articles and presentations |
Researchers interview health care leaders about barriers to implementation and suggest strategies for overcoming them |
Research and data |
Systematic review of interventions that have been used to promote patient involvement in patient safety |
Research and data |
Tools from the Agency for Healthcare Research and Quality (AHRQ) to help prioritize concerns and maximize interactions between providers, patients, and families |
Best practices • For clinicians |
The Swiss Patient Safety Foundation reviews patients’ attitudes toward engagement in error prevention and efforts to increase patient participation |
Research and data |
Research article in BMJ Quality & Safety on factors associated with successful implementation of communication and resolution programs at two Massachusetts hospital systems |
Research and data |
Template for tracking adverse events and CARe process status in Excel |
CARe toolkit |
Policies from the National Practitioner Data Bank, Massachusetts Department of Public Health, and Massachusetts Board of Registration in Medicine |
Laws and regulations |
Suggested language for insurers talking to patients, whether they believe the standard of care was not met or if they are not sure |
Best practices |
Research and foundation for AHRQ's "Guide to Patient and Family Engagement: Enhancing the Quality and Safety of Hospital Care"
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For clinicians • Research and data |
Covers the seven aspects of response to adverse events: initial response, truth-telling, apologies, mediation, root cause analysis, compensation, and reporting |
For clinicians |
Who should be at the initial meeting and what should be discussed
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Implementation guides |
CARe Support, also known as service recovery, aims to cover a portion of the cost incurred by the patient or family members as a result of the adverse event |
Implementation guides |
Interviews with patients and family members after something went wrong in their medical care |
Research and data |
A patient-focused flyer that explains the elements of CARe |
For patients and families |
Study exploring how surgeons currently disclose medical errors |
Best practices • Research and data |
Tips and sample scripts to help risk managers and patient safety staff broach difficult conversations with providers |
Implementation guides |
Project management template with a suggested schedule for sites implementing a CARe program |
CARe toolkit |
Samples, guidelines, and other resources for organizations implementing a new CARe program |
Implementation guides |
Worksheet for organizations adopting their own version of a disclosure and offer program developed by the University of Michigan Health System |
Implementation guides |
Sample PowerPoint presentation with an overview of CARe, background information, and data to support the model |
CARe toolkit |
Strategies to increase awareness internally and externally of patient safety improvements made in response to a CARe case
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Best practices • Implementation guides |
Study from the Massachusetts Medical Society that looks at the frequency and impact of defensive medicine across the state |
Research and data |
Chapter 224 of the Acts of 2012 included several provisions to facilitate implementation of the CARe model |
Laws and regulations |
Three videos depicting the first resolution meeting, the initial conversation between the insurer and patient/family, and the follow-up conversation after an investigation; recorded at the 2018 CARe Forum |
Simulations and case studies |
Study finds a program of full disclosure of medical errors did not increase total claims and liability costs at the University of Michigan Health System |
Research and data |
A perspective in the New England Journal of Medicine describes reforms that can be implemented without requiring changes in the law |
Articles and presentations |
Personal essay by Albert Wu, M.D., M.P.H., on the emotional impact of medical error on clinicians |
Articles and presentations • For clinicians |
Guidance for measuring progress through reporting and analyzing metrics |
CARe toolkit • Research and data |
A risk manager talks to the provider after a medication error to let them know about the error and how they will handle it using the CARe process |
Simulations and case studies |
How to fill out a report with the NPDB in cases where CARe is used |
Implementation guides |
How nontraditional public-policy reforms to medical injury response could lead to safer and higher quality health care |
Articles and presentations |
Researchers at University of Michigan Health System review the "open disclosure with offer" model and offer ideas for tailoring it to other settings |
Research and data |
Implementation of a disclosure and apology model at Baystate Health, an integrated health care system in western Massachusetts |
Articles and presentations |
An example of state legislation supporting open communications and disclosure practices |
Laws and regulations |
The Institute for Professionalism and Ethical Practice and CRICO describe the key components of an effective disclosure program |
Articles and presentations |
Findings suggest that communication and resolution programs will not lead to higher liability costs when hospitals offer compensation proactively |
Research and data |
How to improve communication with patients, from the American College of Obstetricians and Gynecologists |
Articles and presentations |
Patients’ perceived willingness to participate in safety-related behaviors and the potential impact of clinicians' encouragement on their willingness levels |
Research and data |
The role of punitive sanction in the safety of our health care system |
Articles and presentations |
Adding updated fields for CARe cases into the patient safety reporting system |
CARe toolkit |
How health care professionals can enhance patient safety by offering a communicative and relational presence with patients and families |
Articles and presentations • Research and data |
Qualitative analysis looking at whether physicians disclose the information patients desire and if their emotional needs are met when an error occurs |
Research and data |
An investigation into patients' experiences with CRPs to understand aspects of institutional responses to injury that promoted and impeded reconciliation |
Research and data |
Answers to common clinician questions about CARe
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For clinicians |
Attorneys in Massachusetts that have committed to follow a set of best practices and have attended an educational session about CARe |
For patients and families |
Characteristics a health care organization should have in order to implement a successful CARe program |
CARe toolkit |
Short description of how to report to the NPBD for communication and resolution programs, published in National Association Medical Staff Services (NAMSS) Gateway |
Implementation guides |
Considerations for before, during and after a resolution conversation |
CARe toolkit |
Patient relations staff and doctors sit down with family members to explain the results of their investigation |
Simulations and case studies |
White paper introducing an approach to two processes: (1) proactive plan for managing serious adverse events, and (2) reactive emergency response of an organization that has no such plan. |
Articles and presentations |
The University of Illinois Medical Center at Chicago's comprehensive process for responding to patient safety incidents, including full disclosure of harm-causing unreasonable care |
Articles and presentations • Research and data |
Survey of American Society for Healthcare Risk Management members on ways to improve reporting and disclosure of medical errors |
Research and data |
Guide for health care organizations to improve the practice of respect across the continuum of care |
Best practices • Research and data |
Executive summary describing the development of a roadmap for disclosure, apology and offer programs and recommendations for implementation |
Best practices • Research and data |
Sample process timeline of adverse event |
CARe toolkit |
Template for organization's board to show commitment to CARe process |
CARe toolkit |
Spreadsheet to keep track of CARe insurer cases |
Best practices |
Template with information about patient discussions, who to notify, and how to document |
CARe toolkit |
Letter guidance to craft your own messages to patients and families after an adverse event occurs |
CARe toolkit |
Procedure to determine whether an adverse event qualifies for CARe, and to outline the steps that follow |
CARe toolkit |
List of criteria for cases that need closer inspection with a CARe lens; not all will become CARe insurer cases, but they should be flagged
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CARe toolkit |
Literature review of 745 reports about the involvement of patients in patient safety efforts |
Research and data |
Survey of clinicians found that respondents believed formal support should be provided within the institution |
Research and data |
Timothy B McDonald, M.D., J.D. presentation at the University of Illinois covers the basics of implementing a disclosure program |
Articles and presentations |
Nonprofit organization that teaches patients and families about the disclosure movement and how to interact with providers when something goes wrong |
For patients and families |
Slideshow introducing the PEARL program, it's history, how it works, and data on outcomes and measures
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Articles and presentations • Research and data |
Guide to assist those who want to form an alliance to further CARe in their state or region |
Implementation guides |
Handout for facilities to give to patients and families to explain the CARe program |
CARe toolkit • For patients and families |
Research on patients’ and family’ views on how clinicians enact incident disclosure |
Research and data |
Article in the New England Journal of Medicine explores disclosure of adverse events that affect many patients |
Research and data |
Guide explaining the four steps of "disclosure and offer" programs: Communication, investigation, negotiation and resolution |
Implementation guides |
Survey of more than 3,000 physicians finds that medical errors lead to significant emotional distress; researchers recommend improved organizational resources to support providers |
Research and data |
Betsy Lehman Center report on two studies exploring the human and financial cost of medical error in Massachusetts |
Research and data |
Ashley B. Yeats, M.D., FACEP, encourages clinicians to think about adverse events from a patient's perspective |
Articles and presentations |
JAMA "Special Communication" reviews national trends in medical liability claims and costs, and discusses nontraditional reform approaches |
Research and data |
Dr. Alice Coombs presents at the 2021 CARe forum about how to reduce health care disparities and improve outcomes |
Articles and presentations |
Study finds that patients often do not formally report when they believe something went wrong |
Research and data |
Understanding medical malpractice insurance: 2006 primer and 2011 update
Summary on how medical malpractice insurance works, why premiums change, and what can be done about it |
For clinicians • Research and data |
Study finds that U.S. and Canadian physicians' error disclosure attitudes and experiences are similar despite different malpractice environments |
Research and data |
BMJ Quality & Safety article offers practical and ethical reasons for including patient and family perspectives in the incident management process |
Research and data |
Guide with information about responding to an adverse event, suggested language for talking with patients, and FAQs about disclosure and adverse events |
Implementation guides |
Sigall Bell, M.D. presentation on the benefits of disclosure and barriers to overcome |
Articles and presentations |
Case study highlights gaps between patients’ expectations and physicians’ ability for disclosure and apology |
Simulations and case studies |
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