Article Text

Ensuring successful implementation of communication-and-resolution programmes
  1. Michelle M Mello1,
  2. Stephanie Roche2,
  3. Yelena Greenberg3,
  4. Patricia Henry Folcarelli4,
  5. Melinda Biocchi Van Niel4,
  6. Allen Kachalia5
  1. 1 Stanford Law School and Stanford University College of Medicine, Stanford, California, USA
  2. 2 Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  3. 3 Department of Health Policy & Management, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
  4. 4 Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusettss, USA
  5. 5 Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
  1. Correspondence to Professor Michelle M Mello, Stanford Law School, Stanford University, Stanford, CA 94305, USA; mmello{at}


Background Communication-and-resolution programmes (CRP) aim to increase transparency surrounding adverse events, improve patient safety and promote reconciliation by proactively meeting injured patients’ needs. Although early adopters of CRP models reported relatively smooth implementation, other organisations have struggled to achieve the same. However, two Massachusetts hospital systems implementing a CRP demonstrated high fidelity to protocol without raising liability costs.

Study question What factors may account for the Massachusetts hospitals’ ability to implement their CRP successfully?

Setting The CRP was collaboratively designed by two academic medical centres, four of their community hospitals and a multistakeholder coalition.

Data and methods Data were synthesised from (1) key informant interviews around the time of implementation and 2 years later with individuals important to the CRP’s success and (2) notes from 89 teleconferences between hospitals’ CRP implementation teams and study staff to discuss implementation progress. Interview transcripts and teleconference notes were analysed using standard methods of thematic content analysis. A total of 45 individuals participated in interviews (n=24 persons in 38 interviews), teleconferences (n=32) or both (n=11).

Results Participants identified facilitators of the hospitals’ success as: (1) the support of top institutional leaders, (2) heavy investments in educating physicians about the programme, (3) active cultivation of the relationship between hospital risk managers and representatives from the liability insurer, (4) the use of formal decision protocols, (5) effective oversight by full-time project managers, (6) collaborative group implementation, and (7) small institutional size.

Conclusion Although not necessarily causal, several distinctive factors appear to be associated with successful CRP implementation.

  • medical liability
  • malpractice
  • patient safety
  • communication
  • disclosure

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.


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  • Funding This project was funded by grants from Baystate Health Insurance Company, Blue Cross Blue Shield of Massachusetts, CRICO RMF, Coverys, Harvard Pilgrim Health Care, Massachusetts Medical Society and Tufts Health Plan.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Interview transcripts are not available for sharing because they cannot be sufficiently deidentified to protect the identity of the participants.

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