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CARe stands for Communication, Apology, and Resolution. It is a program developed by several hospitals and health care organizations in Massachusetts as an alternative to costly, lengthy and emotionally difficult lawsuits after a medical injury. (Similar approaches are also sometimes referred to as Disclosure, Apology and Offer, or DA&O.) This model is an approach for healthcare systems and liability insurers to respond to cases of preventable harm. When something goes wrong at a hospital or health care office, it is a better way for the patient to receive information, an apology, support, and compensation (if appropriate).

Components of CARe:

  • Communicate with patients and families when unanticipated adverse outcomes occur. 
  • Investigate and explain what happened. 
  • Implement systems to avoid recurrences of incidents and improve patient safety. 
  • Where appropriate, apologize and offer fair financial compensation without the patient having to file a lawsuit.

Objectives of CARe:

  • Improve communication and transparency about adverse outcomes.
  • Support patients and families to help achieve a fair, timely and healing resolution to medical harm.
  • Support clinicians in disclosing unexpected outcomes to patients. 
  • Improve patient safety by learning from errors and near misses and preventing future harm. 
  • Provide an alternative to lawsuits and their unnecessary costs by meeting the financial needs of injured patients and their families quickly in the aftermath of an injury, without resorting to litigation.

Such a system does not deny patients the right to bring legal action, but makes tort a last resort. Adverse events in which the provider or institution is deemed to have provided appropriate care are firmly defended. Regardless of whether the harm was avoidable or not, CARe includes support and the opportunity for emotional healing for both the patient and health care provider.

In addition to maximizing transparency, accountability, and being more ethically appropriate, this approach also maximizes patient safety by capturing many more cases from which the institution and providers can learn and improve their practices.

Why CARe?

The medical liability system has fundamental flaws that are significant barriers to improving patient safety, ensuring fair and timely resolution of medical injury disputes, and controlling the cost of health care. Today in Massachusetts, litigation is the main pathway for harmed patients to seek compensation. Since litigation is an adversarial system, this approach directly threatens the relationship between patient and caregiver. It is also slow, inefficient, and often unfair: a small minority of harmed patients pursue litigation, and only a fraction of those are compensated. Litigation costs, language barriers, and other obstacles may also discourage the most vulnerable patients from understanding how they were harmed, and how to seek compensation. The current system takes a great emotional toll on patients and providers alike – one that can go on for years until the case is resolved. 

For patients, the current system breeds distrust of our healthcare system and blocks efforts to improve patient safety due to fear and secrecy that often surround bad outcomes. For physicians, it results in unaffordable premiums, and for all clinicians and staff a loss of trust in the justice system. It also causes them to view patients as potential litigants, and encourages the practice of defensive medicine. For the health care system as a whole, the current system stalls patient safety efforts, drives up the overall cost of health care, and compromises access to care when liability concerns lead physicians to avoid high risk patients. 

CARe, known in some settings as “Disclosure, Apology and Offer,” is a program intended to serve as an alternative to litigation. 

How CARe works

CARe is about timely communication of important information and supporting families through an adverse outcome. The hospital or healthcare worker will meet with the injured patient and/or family member(s) and:

  • Explain what happened and why; 
  • Apologize; and, 
  • Discuss what will be done to prevent it from happening again. 

The communication process begins immediately following an adverse event, with staff conveying what is known at the time about what happened, how it will affect the patient's care, and how the hospital will support the patient and family. It continues after an investigation by the hospital or health care facility into the injury, when a determination is made by the patient safety team regarding whether or not it was caused by medical management.

In the Resolution stage of the CARe process, hospital representatives explain their findings about what led to the adverse outcome, and whether a medical mistake was involved. If the hospital or health care provider did make a mistake which resulted in the injury, the patient and/or family will meet with representatives of the hospital and its insurance company and family may be offered financial compensation if appropriate. The patient is encouraged to bring an attorney to any meetings, particularly those in which there is a discussion of financial compensation, but an attorney is not required.

If the care leading up to the injury was found to have been reasonable, the patient and/or family are given a thorough explanation and a chance to ask questions to help them understand what occurred. The health care facility also explains that it will stand behind the providers and defend the care in any legal proceedings that the patient or family chooses to bring. It also explains that all cases are rigorously studied as part of a comprehensive patient safety improvement effort.

Giving patients as much information as possible, in a timely manner, helps them to feel more in control and supported. In addition to being ethically more responsible, CARe is more effective at identifying cases from which the institution can learn and improve. It also helps to reinstate clinicians as advocates for their patients by diminishing the fear of litigation.

About CARe

Institutions adopting CARe

Massachusetts pilot sites:

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

Sites in other states
University of Michigan Health Systems
Stanford University Medical Institutions
University of Illinois Medical Center
University of Washington Medical Center


Further reading on CARe

Download a more detailed description here.  

A summer 2012 Vital Signs article provides a further overview of the CARe model.

Another good overview of this type of model, along with related legal developments (up to 2007) and prominent related programs can be found here.

Full list of resources here.

A successful Model

Since 2001, successful implementation of a similar model at the University of Michigan has led to decreased patient injuries and claims as a result of increased reporting, system improvements following investigation of claims, shorter time to claim resolution, and dramatically decreased costs. We hope that in Massachusetts we will also see such positive results.

Click here for access to resources on proven effectiveness, data and Massachusetts legislation.