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Improving Patient Safety With CARe 

Several hospitals in Massachusetts have started a program called "Communication, Apology, and Resolution" or CARe (similar to programs known as Disclosure, Apology and Offer or DA&O). This program is for patients who have been unexpectedly harmed during their medical care. When something goes wrong at a hospital or health care office, this program is an effective way of providing the patient with information, support, and (if appropriate) compensation. It also a good way to make sure that similar experiences don't happen to other patients.

Why is there a need for CARe?

Even though doctors, nurses, and hospitals try to give patients the best care every day, patients can be hurt during medical care. Sometimes, this is because of something that a hospital, nurse or doctor did (or forgot to do). This is referred to as “avoidable” injury. Until CARe, the usual way for a patient to receive compensation to help them through that injury has been to pursue a lawsuit. But a lawsuit can be difficult for both patients and caregivers. A lawsuit may be emotionally draining, and sometimes, patients who deserve compensation have to wait years to receive it, or may not receive it at all.

While the CARe model can help avoid a lawsuit, the legal system still serves an important role in assisting patients to receive just compensation for injuries from errors. Therefore, we strongly encourage patients to consult with an attorney during this process.


How does CARe work?

The first step of CARe is communication. Giving patients as much information as possible and in a timely manner helps them feel more in control and supported, and offers greater opportunity for them to heal from the experience and move beyond it. The hospital or healthcare worker will meet with the injured patient and/or family member(s) and:

  • Provide the patient with as much information as possibly in a timely manner, listen to the patient and family's needs and concerns, and offer support;
  • Initiate an investigation into the injury;
  • Explain what happened and why;
  • Apologize; and,
  • Discuss what will be done to prevent it from happening again.

After the hospital or health care organization's patient safety team looks carefully at the event and what led to the injury, a team of providers will communicate with the patient and/or family members. They may find that the injury was caused by something the hospital or healthcare worker did, or by something else. If the hospital or healthcare worker did make a mistake which injured the patient, the patient and/or family will meet with hospital and insurance representatives. The patient and/or family may be offered financial compensation. The patient is encouraged to bring an attorney to any meetings, in particular those involving an offer of financial compensation.

Sometimes bad outcomes occur during medical care despite the best efforts of the medical team and despite delivery of appropriate and standard care. If the investigation finds that an injury was not preventable, or not a result of medical error, these findings will also be communicated to the patient and/or family.

Click here to dowload a document with more details, or visit our Patient FAQ page.

To reach patient relations at any of our member sites, visit our Institutions page.

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The Patient FAQs
Glossary of Terms Link

Goals of CARe

  1. Support health care workers in communicating with patients about what happened to cause them harm and to preserve the patients' relationship with the care team. When something goes wrong, a health care provider will explain to the patient what happened so that the patient is informed and supported. Health care providers will listen to the patient's concerns, and the patient's questions will be answered.
  2. Offer the patient an apology for injuries that could have been avoided. 
  3. Create a process for timely investigation to prevent the same thing from happening to others by implementing necessary changes and continuously looking for ways to improve. 
  4. Offer patients timely and fair compensation in appropriate cases.

Participating institutions

The following hospitals are currently part of the CARe program:

Beth Israel Deaconess Medical Center in Boston
Beth Israel Deaconess Hospital-Needham
Beth Israel Deaconess Hospital-Milton
Baystate Medical Center in Springfield
Baystate Franklin Medical Center in Greenfield
Baystate Mary Lane Hospital in Ware

Other hospitals and medical groups are at varying stages of adopting the CARe approach. (Coming soon: registry of health care facilities and hospitals and appropriate contact person.)

Patient Stories, Services and Resources available here.