New journal study explores how to implement doctor apology programs, reduce malpractice lawsuits and future medical errors

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A new study in the Journal of Patient Safety and Risk Management, led by Dr. Florence R. LeCraw of Georgia State University, identifies best practices for adopting the well-established principles of diffusion of innovation science (DOI) to build support for adoption of Communication-and-Resolution Program (CRP).

What research is making increasingly clear, however, is that lawsuits are dramatically decreased when doctors can apologize and explain to patients and their families how they will prevent future patients from being injured by the same error.

Medical errors are the third leading cause of death in the United States, and research shows that allowing physicians to offer apologies to patients and their families following errors can reduce malpractice lawsuits by 50 percent and help prevent future patients from experiencing similar harm.

Identifying the best practices for patient, medical, and legal advocates to persuade hospitals and state legislators to adopt one of the most common medical apology protocols—the Communication-and-Resolution Program (CRP)—is the focus of a new paper in the Journal of Patient Safety and Risk Management.

Authored by a team led by Dr. Florence R. LeCraw, an Atlanta physician and Adjunct Professor at Georgia State University, the study, "How U.S. Teams advanced communication and resolution program adoption at local, state, and national levels," identifies best practices for adopting the well-established principles of diffusion of innovation science (DOI) to build support for adoption of CRP. View study here: https://journals.sagepub.com/doi/full/10.1177/2516043520973818

“For decades hospitals, physicians, and their insurance providers and attorneys have insisted on a ‘deny and defend’ approach to medical mistakes,’’ Dr. LeCraw said. “What research is making increasingly clear, however, is that lawsuits are dramatically decreased when doctors can apologize and explain to patients and their families how they will prevent future patients from being injured by the same error.’’

Co-authors with Dr. LeCraw on the paper are Dr. Michael J. McCoy, chief medical officer at Great River Health System in Iowa, and Sally C. Stearns, Ph.D., professor in the Department of Health Policy and Management at the University of North Carolina’s Gillings School of Global Public Health.

CRP is based on providers and hospitals communicating honestly to patients and families about why an unexpected adverse outcome occurred, apologizing if an error occurred, providing compensation, and discussing how they can prevent a recurrence of the error with other patients. Several other studies, cited in the JPSRM study, show that CRP leads to fewer legal claims, reduced defense litigation costs, decreased practice of defensive medicine, and reduced stress for providers during the resolution process.

“Healthcare-professional burnout has increased with the onset of COVID-19 pandemic, to the point where many industry leaders describe it as a public-health crisis,’’ Dr. LeCraw said. “As we note in this new study, peer-reviewed published analysis indicates that compared to ‘deny and defend,’ CRP decreases the stress that physicians and nurses experience after unexpected adverse patient outcomes. The extent to which CRP may decrease the incidence of burnout among healthcare providers is a critically important topic meriting further research and analysis.”

The LeCraw team’s paper reviews the methods nine teams used, drawing on DOI principles, to try to persuade states to enact CRP laws, hospitals to implement CRP, and national medical societies to endorse CRP and educate their members about it. Seven of the teams studied succeeded. Two teams that did not initially achieve success with CRP efforts in New York City and Washington State, in part because they had not incorporated DOI, later applied DOI principles to promote implementation of CRP at Baystate Medical Center and Beth Israel Deaconess Healthcare System in Massachusetts.

The study concludes that to achieve successful implementation of CRP, proponents should:

  • meet with all stakeholders who would be affected by CRP to determine their questions, concerns, and goals
  • identify the opinion leader(s) in each stakeholder group who can best champion CRP to their peers and educate them about the risks, costs, and benefits of the program
  • apply the same principles of DOI that are used to advanced evidence-based healthcare policies and practices to promote CRP and other policies that improve the public good, in particular through concise, easily read one-page handouts

"Apology programs are most likely to be adopted and to succeed when physicians are willing to take ownership of these programs and persuade their colleagues that apologizing for medical errors is not only the ethically right thing to do, it’s the smart thing to do to improve our patients’ safety and reduce malpractice and defensive medicine costs,’’ Dr. LeCraw said.

To date, more than 200 hospitals in the United States have implemented physician apology programs such as CRP. Colorado, Iowa, Oregon, and Massachusetts have adopted statewide legislation facilitating implementation of CRP by healthcare systems and providers.

Media Contact:
Peter J. Howe, 617-482-0042, phowe(at)denterlein(dot)com

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Merina Zeller
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