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"Studies show that the most important factor in people's decisions to file lawsuits is not negligence, but ineffective communication between patients and providers." Clinton & Obama, NEJM 2006

"Malpractice suits often result when an unexpected adverse outcome is met with lack of empathy from physicians and a perceived or actual withholding of essential information." Vincent C, The Lancet 1993

The above quotes exemplify what is wrong with the current medical liability system, in which litigation is the main pathway for harmed patients to seek compensation. 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 liabilty concerns lead physicians to avoid high risk patients.

Communication, Apology, and Resolution (CARe) is an alternative process designed to make tort the last resort. Built upon a culture of safety that relies on solid root cause analysis, it includes full disclosure and explanation, apology when appropriate, and timely and fair injury compensation. Visit our About section for background on the CARe approach in Massachusetts and on MACRMI.

Administrator FAQs

Institutional Goals of CARe

The overall goals of CARe are to create an environment in which patient injuries are addressed rapidly and appropriately, and patient safety improves through learning from adverse events. Specific goals within the CARe initiative include:

  • Ensuring that all adverse events are reported and analyzed for "root causes;"
  • Ensuring that whenever there is signficant patient harm, there is an effort to assess preventability and implement changes to prevent recurrence;
  • Ensuring that patients receive communication regarding the adverse event and what is being done to prevent it from happening again;
  • Ensuring that there is an attempt for early resolution with the patient and/or family through a full explanation, an apology, and compensation when appropriate.

Download an article on malpractice reform and opportunities for leadership by health care institutions and liability insurers in the New England Journal of Medicine, 2010.