A Different Approach: Communication And Resolution Programs In Hospitals

The Wall Street Journal recently ran an interesting article entitled: “Hospitals Find A Way To Say, ‘I’m Sorry'”. The article centered on the communication and resolution programs (“CRP”) that several hospitals have implemented. CRPs are like an in-house alternative dispute resolution program that allows hospital and patients to communicate about medical errors that were committed by the hospital and resulted in harm to the patient or the loved one of a patient.

The Collaborative for Accountability and Improvement is working to implement these CRP programs at hospitals across the country. The programs “require a commitment from hospital administrators and physicians to be transparent about risks and adverse events.” The staff at a hospital is trained to report any issues right away without fearing punishment for disclosing mistakes. The results of investigations into the reported issue are then supposed to lead to new preventive measures being implemented by the hospital to prevent further similar issues.

The programs provide patients with emotional support and potentially financial compensation. In addition, patients “can still seek legal representation at any time.” Most importantly, the hospital acknowledges mistakes and apologizes to patients.

An example of one such program is the PEARL program that Stanford Hospital implemented a decade ago. PEARL stands for “Process for Early Assessment, Resolution, and Learning.” The meaning of the “L” was recently changed from “Loss” to “Learning” because Stanford felt that it “better reflected the process, which includes learning from adverse events.”

Patients who enter the program are often first greeted by someone who has been through what they are going through, like Leilani Schweitzer, the assistant vice president for communication and resolution. Schweitzer lost her son after a nurse’s error soon after Stanford started the PEARL program. She said the hospital “immediately admitted the error, apologized, answered her questions and promised they would make sure it never happened to another child.” In addition to an apology, Schweitzer was provided with compensation. After working as a patient advocate and creating a foundation, she joined the Risk Authority in 2015.

Schweitzer was the one to greet Gary Avila, a 64-year old pastor from Palo Alto, California and another PEARL program participant. During an operation on Avila’s arm, the surgeon accidentally nicked a nerve. The injury, which Avila described as “painful beyond words,” affected the use of his hand.

When contacted by Schweitzer, Avila said it was the first time he had ever received an apology from a hospital. The PEARL program classifies adverse events on a severity scale and determines if compensation is needed based on where the event falls on the scale. The program may compensate a patient who “experienced harm or distress, even if an investigation determines the standard of care was met.” In Mr. Avila’s case, the hospital determined that the nerve injury was an “unanticipated outcome” meaning it was not intended but “not necessarily the result of error or negligence.” His injury on the severity scale was classified as a “permanent minor” injury. As part of the program Avila received an apology as well as “an explanation of what had gone wrong, and a waiver of his medical bill” in addition to a confidential monetary settlement for his pain and suffering.

Overall, the program at Stanford has been effective in reducing malpractice costs. Stanford reported that “from 2009 to 2014, after Pearl was implemented, the frequency of lawsuits was 50% lower, and indemnity costs in paid cases were 40% lower compared with 2003 to 2008.”

Hospitals were initially reticent to adopt such programs. Doctors were reluctant to admit mistakes for fear of liability and disciplinary repercussions. Risk managers for hospitals were reluctant to make financial offers without the threat of a lawsuit. But these attitudes are changing. Pressure from groups like patient safety organizations and lawmakers, as well as changing medical malpractice laws have made hospitals more receptive to CRP programs. In fact, an upcoming training seminar hosted by the Collaborative for Accountability and Improvement is already sold out. If such receptiveness continues, these programs could become a much more common way for hospitals to handle error and negligence issues.