In an ongoing effort to assist healthcare systems and clinicians improve patient safety, the Agency for Healthcare Research and Quality (AHRQ) is offering a new online toolkit aimed at helping clinicians better communicate with patients and caregivers in situations when something goes wrong with a patient’s care.
The toolkit implements a process called Communication and Optimal Resolution (CANDOR), a process that hospitals and health systems can draw on to immediately respond when a patient has been harmed due to medical care. The toolkit is built on the premise that candid, empathetic communication delivered in a timely manner fosters trust between the clinician and patient/caregiver and ultimately improves patient safety.
“The program is intended to support all types of healthcare organizations and systems to remove barriers to the reporting of near misses and errors and to encourage open communication about how to prevent future harms,” said Jeff Brady, MD, director of the AHRQ Center for Quality Improvement and Patient Safety.
According to Dr. Brady, the CANDOR toolkit was developed based on the best practices already in use by some U.S. health systems and hospitals. “Evidence collected from hospitals that have developed communication and resolution programs show such initiatives reduce liability costs and increase appropriate resolution when something goes wrong,” he said.
The need for such a toolkit is highlighted by both the numbers that show that medical errors are not uncommon as well as by a common response by many hospitals and providers to remain silent about the error. “CANDOR is necessary because the culture in many institutions results in a ‘wall of silence’ following an adverse event,” wrote AHRQ director Andy Bindman, MD, in a post on May 23, 2016, on the blog “AHRQ Views.” He says he understands this response given the range of emotions—from confusion and fear to embarrassment and guilt—that clinicians may feel when an adverse event occurs.
“We work so hard to diagnose and heal patients,” he wrote, “but we are usually unprepared to talk about adverse events and medical errors when they occur.”
Dr. Bindman said that CANDOR “envisions a different approach” whereby hospitals and providers recognize that adverse events do happen and proactively disclose the harm to patients and their caregivers as soon as possible.
There are many benefits of explaining safety events to patients as well as providing an apology when appropriate, said Dr. Brady. Using CANDOR, he added, provides a systems-based approach to both embracing a culture of patient safety as well as a strategy to avoid repeat adverse events. However, he emphasized that hospitals that currently do not have communications and resolution programs may proceed cautiously when considering CANDOR as it represents a “new way of doing business.”
“For those facilities, the challenge is convincing decision makers to reconsider postures that limit the sharing of information and avoid an admission of fault,” he said.
The CANDOR toolkit includes facilitator notes, slides, and online videos and is available free of charge.