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Making communication and resolution programmes mission critical in healthcare organisations
  1. Thomas H Gallagher1,
  2. Richard C Boothman2,
  3. Leilani Schweitzer3,
  4. Evan M Benjamin4
  1. 1Department of Medicine, University of Washington, Seattle, Washington, USA
  2. 2Boothman Consulting Group, LLC, Ann Arbor, Michigan, United States
  3. 3The Risk Authority, Stanford Medicine, Palo Alto, CA, United States
  4. 4Ariadne Labs, Harvard School of Public Health and Brigham & Womens Hospital, Boston, MA, United States
  1. Correspondence to Dr Thomas H Gallagher, Department of Medicine, University of Washington, Seattle, WA 98040, USA; thomasg{at}

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Patients entrust their lives to healthcare providers. Healthcare providers, in turn, aim to promote wellness, heal what can be healed and relieve suffering, all with comfort and compassion. Yet, when patients are harmed by their healthcare, too often they experience defensiveness and disregard that actually exacerbates their suffering, adding insult to injury.1 2 Communication and resolution programmes (CRP) can mitigate this further harm and avoid pouring salt on the wounds of patients whom the healthcare system has hurt instead of helped. These programmes strive to ensure that patients and families injured by medical care receive prompt attention, honest and empathic explanations, sincere expressions of reconciliation including financial and non-financial restitution, and reassurance from efforts to prevent future harm to others.3 Decades of study and interest in CRPs seem to be resulting in increased implementation with the hope that supporting patients, families and caregivers after harm could become the norm rather than the exception.4

Yet a central problem looms, and unless effective solutions are enacted, the potential of CRPs may go largely unrealised. The field is rife with inconsistent implementation, which often reflects a selective focus on claims resolution rather than a fully implemented (‘authentic’) CRP.5 Inconsistent CRP implementation means that fewer patients and families benefit from this model and opportunities for improving quality and safety are missed. Authentic CRPs, in contrast, are comprehensive, systematic and principled programmes motivated by fundamental culture change which prioritises patient safety and learning. In an authentic CRP, honesty and transparency after patient harm are viewed as integral to the clinical mission, not as selective claims management devices.6 CRPs appear to improve patient and provider experiences, patient safety, and in many settings lower defence and liability costs in the short term and improve peer review and stimulate quality and safety over …

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