Despite everyone's best efforts, adverse events and outcomes, whether caused by error or not, do occur. Under the current professional liability system 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 toxic to patient safety, and drives unaffordable defensive medicine. 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.
An alternative approach to adverse outcomes is DA&O, which stands for "Disclosure, Apology and Offer" and refers to a program used at several health care organizations throughout the nation as a way to provide open and honest communication with patients and families after adverse events, in addition to financial compensation in cases where patients were harmed because the standard of care was not met. In Massachusetts, DA&O is also called "CARe" – Communication, Apology, and Resolution.
The CARe model promotes an institutional response to unanticipated clinical outcomes in which health care organizations follow these steps:
- Proactively identify adverse events;
- Distinguish between injuries caused by medical negligence and those arising from complications of disease or intrinsically high-risk medical care;
- Offer patients full disclosure and honest explanations;
- Offer an apology with rapid and fair compensation when standards of care were not met.
Such programs have gained national attention after reports showed dramatically decreased number of claims, decreased time to resolution, and decreased overall costs, as well as improved patient safety.
The CARE system does not deny patients the right to bring legal action, but would make tort a last resort. Adverse events in which the provider or institution is deemed to have provided appropriate care are firmly defended.
In addition to maximizing transparency, accountability, and being morally the right thing to do, this approach also maximizes patient safety by capturing many more cases from which the institution and providers can learn and improve their practices.