This month, a think tank of driven, dedicated professionals met again to discuss one of the most important goals in healthcare: improving patient safety. This year’s National Patient Safety Foundation’s Lucian Leape Institute’s annual conference focused on communication and resolution programs (CRPs). But because CRPs are still emerging as a best practice, and not everyone is familiar with them, this is an excellent opportunity to offer a brief overview.
What is a CRP?
Though the definition of a CRP is relatively straight forward, the idea is not. A communication and resolution program is a process that healthcare organizations may use for the early investigation of unanticipated, adverse medical outcomes; to handle claims associated with them; to communicate about the event with patients; and to resolve the situation with appropriate measures. Successful CRPs require transparency and openness, and do whatever they can to ease the burden of patients and families who have suffered harm.
What does a CRP do?
Communication and resolution programs work on several levels.
They can reduce legal expenses by providing the foundation for managing risk and claims proactively. Their investigatory component can help providers and organizations to learn from adverse medical outcomes and make safety improvements. And, importantly, CRPs can help patients to heal and otherwise become whole. Each of these pieces is vital to overall patient engagement – by giving each aspect attention, the patient can experience the best possible care, and the program can create institutional value.
Communication and resolution programs are relatively new, and are often misunderstood. Many in the fields of insurance and healthcare have spent so long practicing “deny and defend” that the idea of voluntary communication and transparency may seem counter intuitive. But CRPs are not only the right way to do business for patients and providers, allowing them opportunities for healing and growth, they also make good business sense.
Do CRPs really work?
From our experience at The Risk Authority Stanford, they do. Our CRP is called PEARL, the Process for Early Assessment, Resolution and Learning, and to date it has achieved measureable success. The results of PEARL reveal a promising future, conveying improved satisfaction among patients, caregivers, and physicians after unexpected outcomes, as well as improving patient safety to prevent future adverse events.
PEARL has even been shown to reduce costs without increasing litigation. Stanford Law School recently conducted a study that demonstrates PEARL’s success. A pre/post analysis of 2003-2008 vs. 2009-2014 shows that after PEARL was implemented, the frequency of lawsuits was 50% lower, indemnity costs in paid cases were 40% lower, and defense costs were 20% lower for cases handled through PEARL.
What do CRPs need to work?
The possibilities CRPs provide are exciting and energizing, but the fact is they can’t survive in a vacuum. We’ve found that CRPs need several things to survive long-term:
- Culture: A culture that is both safe and supportive of transparency and openness. This includes putting practices into place that actively support this culture, such as creating a strategic roadmap to develop and maintain transparency, and creating processes to address behaviors, performance standards, violations of practices, and other actions that don’t align with the tenets of the culture.
- Patient Engagement: Patients need to know and understand the role of the CRP in their care. Without their engagement and support, the program cannot succeed.
- Healthcare Professionals: Physicians and providers must be included in the conversation and shown the benefits of the CRP. It’s imperative that they understand the program is not punitive; rather it’s an opportunity to help patients understand what has happened, and an avenue of recovery for all involved in the event.
What’s holding us back?
The ingredients for a successful CRP are complex and multifaceted, but the facts are that patient safety and engagement are some of the most important and game-changing issues in need of attention.
If we can strengthen business practices while doing the right thing, why wouldn’t we? If we can improve safety, heal patients and help providers, while also reducing the human and financial costs associated with medical error, shouldn’t we?
We think so, don’t you?