Apologizing to patients for bad outcomes from medical error through CRP isnâ€™t just the right and honorable thing for physicians to do, it greatly reduces legal costs, stress, and needless, costly practice of defensive medicine by physicians.
ATLANTA and CHATTANOOGA, Tenn. February 16, 2018
For years, a growing body of research has documented how physicians' willingness to explain and apologize for adverse medical outcomes can substantially reduce lawsuits and litigation expenses.
Now, the first U.S. peer-reviewed, journal-published study of an â€œopenâ€? hospital system where doctors have to pay for their own insurance (as opposed to being covered by a hospital insurance policy) and are not employed by the hospital shows that a “Communication-and-Resolution Program” (CRP) cut lawsuits by two-thirds and reduced legal expenses and the time needed to resolve claims by more than 50 percent compared to before CRP was implemented.
The study, being published today in â€œThe Journal of Patient Safety and Risk Management,â€? examines 12 years of data (2004 through 2015) from Erlanger Health System in Tennessee, a five-hospital system based in Chattanooga that treats 600,000 people annually. The study was led by Dr. Florence R. LeCraw of Georgia State University in Atlanta and St. Joseph/Candler Hospital System in Savannah.
Erlanger starting in 2009 adopted a version of CRP known as â€œCollaborative Communication Resolution Process,â€? with these key elements:
Dr. LeCrawâ€™s study, conducted along with specialists from Erlanger and Georgia State, found that over the 12-year period, this CRP protocol led to a 66 percent reduction in legal claims filed, 51 percent reduction in defense costs, and 53 percent reduction in the time required to close cases. These results generally mirror (see table below) the findings from two leading earlier studies in the field of medical apology.
The LeCraw study was the impetus for Medical Association of Georgia leader John Antalis, MD, to submit a resolution by the Medical Association of Georgia to the American Medical Association to endorse CRP as a viable malpractice resolution practice. The study was cited when the American Medical Associationâ€™s House of Delegates voted to adopt its Resolution 227 supporting CRP at its November 12, 2017, meeting. The resolution states, in part: â€œ[E]arly communication and resolution programs are an effective way to learn from medical errors and near misses, enhance patient safety, and improve the liability system â€¦ [M]ultiple studies have already shown the benefits of this early communication and that our AMA does not need to conduct a study to demonstrate effectiveness.â€?
Dr. LeCraw says of the new study:
â€œThe AMA vote and the results from our study add further confirmation that apologizing to patients for bad outcomes from medical error through CRP isnâ€™t just the right and honorable thing for physicians to do, it greatly reduces legal costs, stress, and needless, costly practice of defensive medicine by physicians. In direct contrast to the â€˜deny and defendâ€™ legal approach to medical error, CRP accelerates the process of improving the quality of healthcare delivery. CRP empowers everyone involved in episodes with negative outcome to communicate openly and transparently about what went wrong, and to focus quickly on how these adverse outcomes can be prevented in the future.â€?
Earlier studies have covered â€œclosedâ€? systems where physicians are employees of hospital systems, not independent affiliates, and may experience different personal, professional, and financial incentives for being willing to apologize for adverse medical outcomes.
The Erlanger findings are similar to the University of Michigan Health Systemâ€™s and University of Illinois Hospital Systemâ€™s results that implemented CRP (Illinois: Lambert BL, Centomani NM Smith KM, Helmchen LA, Bhaumik DK, Jalundhwala YJ, McDonald TB. The Seven Pillarsâ€? response to patient safety incidents: effects on medical liability processes and outcomes. Health Services Research J 2016; 51(6):2491-2515. Michigan: Kachalia A, Kaufman SR, Boothman R, et al. Liability claims and costs before and after Implementation of a medical error disclosure program. Ann Intern Med. 2010; 153:213-21)
In the percentage by which CRP reduced claims filed, the LeCraw/Erlanger study showed a 66 percent reduction, compared to 47 percent for Lambert/Illinois and 56 percent for Kachalia/Michigan. The three studies also showed reductions in defense costs (by 51 percent, 82 percent, and 61 percent respectively), settlement costs (27/50/58), total liability costs (43/40/59) and time required to close cases (53/59/30). Dr. LeCraw said of the comparison between her study and the Lambert and Kachalia studies: â€œBecause these are studies of different hospitals in different states in different years, itâ€™s challenging to make statistically significant direct comparisons of our specific data points. However, what you see at a high level is how all three studies demonstrate how clearly and significantly CRP reduces legal claims, legal costs, and the time needed to resolve cases of adverse medical outcomes.â€?
The collection of CRP studies demonstrates that CRP can be beneficial to patients and physicians, lower healthcare costs, and improve the quality of healthcare, unlike the dominant “deny and defend” practice in the U.S.
Dr. Florence R. LeCraw, 404-998-9666 frlwatts(at)gmail(dot)com
Peter J. Howe, 617-482-0042 phowe(at)denterlein(dot)com