Clinicians, patients or attorneys alert the risk management office when an adverse event occurs.

Risk management activates support services for the involved clinician(s) (offer of communication coaching and peer support).

Communication with the patient about the event takes place and is documented in the medical record.

The hospital, led by risk management or patient safety, conducts an internal investigation, which may involve multiple departments and external review.

The hospital reaches a determination about whether the event satisfies the CARe compensation criteria: temporary-severe harm or greater; causally related to medical care; and attributable to a deviation from the standard of care.

If the criteria are met, or if the event came to the hospital’s attention as a prelitigation notice, the event is referred to the hospital’s insurer.

The insurer conducts its own review of whether CARe compensation criteria are satisfied, incorporating information from hospital’s review, medical record and (as needed) other external reviews.

Hospital and insurer identify patient safety lessons.

Hospital and insurer discuss the approach to resolving the event with the patient.

Hospital and insurer representatives communicate investigation findings to the patient, ordinarily in a face-to-face meeting, after advising him/her that they may involve legal counsel.

Patient is offered an empathetic apology appropriate to the situation.

Patient is asked what his/her needs and concerns are.

Patient is offered compensation if criteria were met. In addition, or as an alternative where compensation criteria were not met, ‘service recovery items’ (eg, meal vouchers, medical bill waivers) may be offered as gestures of goodwill.

Multiple meetings may be held as needed to work towards resolution.

Hospital feeds patient safety lessons identified in the investigation into its quality and safety improvement system for further action.