A new patient safety measure from the Centers for Medicare and Medicaid Services brings renewed attention to the value of using a communication and resolution approach to meet the needs of patients and families after harm events.
Acceptance of this approach has reached a “tipping point,” according to Melinda Van Niel, M.B.A., Betsy Lehman Center’s Program Director for CARe, which stands for Communication, Apology and Resolution.
Communication and resolution programs (CRPs) such as CARe are expected to draw additional interest in Massachusetts and across the country, Van Niel says, after new expectations were set in a patient safety structural measure from CMS asking hospitals to attest to their investment in an “evidence-based communication and resolution program.”
CARe includes the elements CMS says should be part of a CRP: open and ongoing communication with patients and families; harm event investigation, prevention, and learning; clinician support; and appropriate resolution (financial and non-financial) for patients and families, she notes.
“In Massachusetts, CARe has reached a tipping point,” says Van Niel. “Most organizations know and accept that this is what they should do when something has gone wrong in a patient’s care,” she says. “The next question is, ‘How do we do it?’”
The Betsy Lehman Center helps organizations build needed capacity
The Betsy Lehman Center is available to support any health system in Massachusetts interested in embedding a reliable CARe program into its work.
The Center offers, free of charge, a structured implementation framework, extensive resources, coaching and collaborative discussion sessions that regularly take place among all participating organizations. The CARe model is informed by the experience of its users — clinicians, administrators, lawyers and insurers, as well as patients and families — and is currently in use in 16 sites in Massachusetts, and several additional organizations are in the process of implementation
A small handful of hospitals were the first to implement CARe in 2012. In recent years, other settings have adopted the model, including physician practices and organizations of different sizes and represented by a wide range of liability insurers.
Van Niel says experience with a diversity of users is a new strength of the program. “Uniformity of best practices, methods, tools and algorithms is important,” Van Niel says, “but it can be challenging to apply them to your unique setting. We help coach organizations through all the key steps, and our diverse community of users supports each other through challenges”
On-demand video simulations are among the resources developed by CARe users
A suite of resources are available online that have been vetted by organizations that use CARe and collaborate on resource development.
Among the most helpful are a series of video simulations, based on real cases, that serve as examples to help guide difficult conversations between provider organizations and patients. One video, for example, offers a model for an initial “disclosure” conversation, letting the patient know about an error in their care. Another demonstrates a way to discuss findings from an event investigation with a patient, family members and their attorney.
The Betsy Lehman Center also organizes quarterly meetings of individuals at health care organizations that oversee CARe work, as well as an annual forum. The 11th annual CARe Forum will be held in Boston on April 11, 2025.
