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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.

Helpful Resources:

The text of the Federal Liability Reporting Requirements and state provisions is available for download here.

Click here for an opinion piece by Dr. Alan Woodward, past president of the Massachusetts Medical Society, on this model.

Download a presentation by Thomas H. Gallagher, MD, of the University of Washington School of Medicine on recent developments and future directions in disclosure.

The Agency for Health care Research and Quality (AHRQ) shares some of the University of Michigan results, highlighting the reduction in malpractice claims as a result of their disclosure program.

Testimonials

“Compassion, honesty, and transparency are at the core of healing relationships. CARe speaks to our need to treat patients and families with respect and dignity when a preventable medical error occurs. Because 1/3 of physicians have experienced a medical error occurring to themselves or a loved one as a patient, CARe also speaks to what clinicians want for themselves and family members.”

Randolph Peto, MD, MPH, Medical Director for Quality and Patient Safety, Baystate Medical Center

"The CARe program is good for patients, providers, and our overarching goal of improving patient safety. Neither patients nor providers benefit from the current system where it can take years to resolve one case and in the end nobody wins. The CARe program is simply the right solution because it's the right thing to do."

Peter Smulowitz, MD, Emergency Medicine, Beth Israel Deaconess Medical Center

“Massachusetts hospitals are committed to always improving the quality and safety of the care they provide to patients. Aside from being fair to caregivers and patients, MACRMI's communication, apology, and resolution initiative will help advance this fundamental quality-improvement agenda by fostering open discussion among clinicians about the causes of adverse outcomes and the steps that need to be taken to avoid them in the future.”

Massachusetts Hospital Association

"As we move toward greater transparency in health care, patients and providers both stand to benefit greatly from disclosure and apology for errors. Coupling disclosure and apology with thoughtful and proactive offers of compensation to patients can better help resolve these difficult events not only more quickly, but more fairly."

Allen Kachalia, MD, Brigham and Women's Hospital and associate professor at the Harvard School of Public Health.

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Helpful Resources:

Testimonials

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