What is Early Resolution in Healthcare?
While organizations call this new wave of risk programs by different names (Early Resolution Program, Communication and Resolution Program, Culture of Safety, etc.), the underlying philosophy is the same. Early resolution is a partnership between healthcare organizations, insurers, patients, and providers to encourage disclosure of patient harm events and proactive risk management to build a culture
of safety with open communication.
Early resolution pivots away from the outdated approach of denying claims at all costs by seeking a fair and productive resolution that keeps patients involved. Rather than a top-down policy, early resolution is usually an organization-wide effort. Early resolution strategies prioritize identifying potential malpractice events as early as possible to resolve the issue and identify systematic failures. By investigating the systems that allowed an adverse event to happen, healthcare leaders reduce pressure on individual healthcare providers and build new protocols that prevent accidents.
Another element of early resolution is communication. While a hospital's administration may pioneer the program, early resolution depends on open communication between all parties: risk and patient safety departments, providers and patients, legal counsel, and patient families.
The Real-World Benefits of Early Resolution
Not only does early resolution make logical and ethical sense, but the strategy also yields real-world benefits for healthcare organizations.
For example, CentraCare adopted the Communication and Optimal Resolution (CANDOR) program that recommends communicating all steps in the claim investigation process with the patient and their family. This way, patients feel heard, and providers can empathize with their patients without fearing legal consequences. As an added benefit, an early resolution culture empowers physicians to level up their care and communicate adverse patient events before they escalate. This translated to impressive patient safety numbers, such as doubling the malpractice event reporting while reducing the rate of high-risk malpractice events per 1,000 births by half.
The "Michigan Model" of claims resolution boasted impressive results for UMHS (University of Medicine and Health Sciences), one of the early adopters of early resolution. After refining the program for several years, UMHS reported a 25 percent lower claims rate and a decrease in the monthly liability cost rate. The program works with a Michigan law that protects the hospital committee's review of the event from legal discovery. The Massachusetts Alliance for Communication and Resolution, an alliance of patient advocacy groups, also pioneered a form of early resolution in its CARe program. Care stands for Communication, Apology, and Resolution. Taking inspiration from the earlier Michigan example, the 2012 report adopted a "disclosure, apology, and offer" approach to resolve malpractice claims quickly.
Other examples, like Stanford University Medical Center’s PEARL (Process for Early Assessment, Resolution, and Learning) show a significant shift in how hospitals handle risk and adverse events. The program is rooted in a belief that open communication means patients and providers can begin healing from the incident as soon as possible. Cheryl Callaghan (formerly DeKleine), VP of Claims at Ascension Health, explained the approach to American Healthcare Leader.
“We will approach the patient, and their family, and tell them we made a medical
mistake. We will answer their questions as best we are able; and if it’s appropriate,
we will compensate them. It’s our belief that this will help heal the patient and
their family. It also helps heal the healthcare provider, who has to live with
having made a mistake, and the system as a whole because we can learn from our mistakes, predict better practices, and improve patient safety.”
Learn More about Early Resolution
While early resolution strategy has seen a surge in visibility over the past five years, it is by no means a new technique. Learn about the history of early resolution, significant obstacles to implementation, and "I'm Sorry" laws in Medplace's Early Resolution Toolkit.
