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When a patient is harmed, the provider’s response is a crucial factor for all parties in healthcare, not only for mitigating liability risks but even more importantly for improving care. Effective CRPs are a valuable tool for all providers.

Dr. Gallagher noted: “Every healthcare provider, organization, and liability insurer should be familiar with communication and resolution programs (CRPs), which are emerging as a best practice for preventing and responding to patient harm events. CRPs are comprehensive, principled, and systematic programs that involve several elements, including early incident reporting; open, ongoing, and empathic communication with patients in families; careful event analysis and prevention planning; care for the caregiver; and financial and non-financial resolution.”

“The return on investment of implementing a highly reliable communication and resolution program is broad, not only related to improving the quality and safety of healthcare, but also creating stronger relationships with patients and families, improving provider well-being, and enhancing patient, family, and public trust. All these benefits can be achieved without an increase in liability expenses. In fact, several published studies have shown an improvement in liability expenses after CRP implementation. The most common mistake healthcare organizations and liability insurers make when implementing a CRP is using it inconsistently, meaning applying the CRP approach to some harm events and not others, or not using the entire model for an individual harm event. This inconsistent implementation significantly impairs the ability of CRPs to support highly reliable cultures of safety and accountability, which are key to achieving the full benefits of these programs,” he explained.

The process of responding to an incident of patient harm should begin before a harm event ever happens. Dr. Gallagher advised: “It is critical that providers know what the expectations are at their organization or from their liability insurer for responding to patient harm events, as well as the resources available to support them in this response. Knowing in advance what the local resources and expectations are can help providers respond in a thoughtful, empathic, yet disciplined way. Sometimes, in the heat of the moment following a patient harm event, providers’ natural human reflexes are to either keep uncomfortable information to themselves or share information with patients that is not fully verified, leading to providers responding less effectively than they should.”

“The first steps a provider should take after an incident of patient harm includes notifying the organization or their insurer immediately that the harm event has happened, and then to prepare a thoughtful approach to talking with the patient about what happened. In this initial notification, it is imperative to share only the known facts about what occurred, which often may be very limited before a full investigation has been conducted. Given that, the initial notification to a patient from a provider about a harm event is often limited to the fact that an unexpected event has happened, what is clearly known about the event, its impact on the patient’s health, what steps are being taken to respond to the event and minimize or mitigate any immediate harm the patient may be experiencing, and a brief description of the process that will follow in terms of an event review. Speculation and blaming other providers should be avoided at all costs,” he said.

“It is equally important that the provider communicates empathically, acknowledging and validating the patient’s emotions and demonstrating that they care about what happened. An expression of regret, such as ‘I’m so sorry that this happened to you’ is appropriate after any incident of patient harm. A fault-admitting apology, such as ‘I am so sorry you were harmed by this error in your care’ is only appropriate after a comprehensive event review has been done and after careful consultation with risk management,” Dr. Gallagher added.

Clear communication, empathy, and thoughtful risk management are all keys to mitigating errors in healthcare and responding to those incidents when errors lead to harm.

For more information about healthcare risk management solutions and resources, please visit www.bhspecialty.com.

Leo Carroll is Senior Vice President and Head of US Healthcare at Berkshire Hathaway Specialty Insurance. He is responsible for the strategic growth and performance of the group’s Healthcare Professional Liability products.

Berkshire Hathaway Specialty Insurance (www.bhspecialty.com) provides commercial property, casualty, healthcare professional liability, executive and professional lines, transactional liability, surety, marine, travel, programs, accident and health, medical stop loss, homeowners, and multinational insurance. The actual and final terms of coverage for all product lines may vary.  It underwrites on the paper of Berkshire Hathaway's National Indemnity group of insurance companies, which hold financial strength ratings of A++ from AM Best and AA+ from Standard & Poor's. Based in Boston, Berkshire Hathaway Specialty Insurance has offices in Atlanta, Boston, Chicago, Columbia, Dallas, Houston, Indianapolis, Irvine, Los Angeles, New York, Plymouth Meeting, San Francisco, San Ramon, Seattle, Stevens Point, Adelaide, Auckland, Barcelona, Brisbane, Brussels, Cologne, Dubai, Dublin, Frankfurt, Hong Kong, Kuala Lumpur, London, Lyon, Macau, Madrid, Manchester, Melbourne, Munich, Paris, Perth, Singapore, Sydney, Toronto, and Zurich.

The information contained herein is for general informational purposes only and does not constitute an offer to sell or a solicitation of an offer to buy any product or service. Any description set forth herein does not include all policy terms, conditions and exclusions. Please refer to the actual policy for complete details of coverage and exclusions.