Ensuring successful implementation of communication-and-resolution programmes.
communication
disclosure
malpractice
medical liability
patient safety
Journal
BMJ quality & safety
ISSN: 2044-5423
Titre abrégé: BMJ Qual Saf
Pays: England
ID NLM: 101546984
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
30
08
2019
revised:
23
12
2019
accepted:
02
01
2020
pubmed:
22
1
2020
medline:
16
9
2021
entrez:
22
1
2020
Statut:
ppublish
Résumé
Communication-and-resolution programmes (CRP) aim to increase transparency surrounding adverse events, improve patient safety and promote reconciliation by proactively meeting injured patients' needs. Although early adopters of CRP models reported relatively smooth implementation, other organisations have struggled to achieve the same. However, two Massachusetts hospital systems implementing a CRP demonstrated high fidelity to protocol without raising liability costs. What factors may account for the Massachusetts hospitals' ability to implement their CRP successfully? The CRP was collaboratively designed by two academic medical centres, four of their community hospitals and a multistakeholder coalition. Data were synthesised from (1) key informant interviews around the time of implementation and 2 years later with individuals important to the CRP's success and (2) notes from 89 teleconferences between hospitals' CRP implementation teams and study staff to discuss implementation progress. Interview transcripts and teleconference notes were analysed using standard methods of thematic content analysis. A total of 45 individuals participated in interviews (n=24 persons in 38 interviews), teleconferences (n=32) or both (n=11). Participants identified facilitators of the hospitals' success as: (1) the support of top institutional leaders, (2) heavy investments in educating physicians about the programme, (3) active cultivation of the relationship between hospital risk managers and representatives from the liability insurer, (4) the use of formal decision protocols, (5) effective oversight by full-time project managers, (6) collaborative group implementation, and (7) small institutional size. Although not necessarily causal, several distinctive factors appear to be associated with successful CRP implementation.
Sections du résumé
BACKGROUND
Communication-and-resolution programmes (CRP) aim to increase transparency surrounding adverse events, improve patient safety and promote reconciliation by proactively meeting injured patients' needs. Although early adopters of CRP models reported relatively smooth implementation, other organisations have struggled to achieve the same. However, two Massachusetts hospital systems implementing a CRP demonstrated high fidelity to protocol without raising liability costs.
STUDY QUESTION
What factors may account for the Massachusetts hospitals' ability to implement their CRP successfully?
SETTING
The CRP was collaboratively designed by two academic medical centres, four of their community hospitals and a multistakeholder coalition.
DATA AND METHODS
Data were synthesised from (1) key informant interviews around the time of implementation and 2 years later with individuals important to the CRP's success and (2) notes from 89 teleconferences between hospitals' CRP implementation teams and study staff to discuss implementation progress. Interview transcripts and teleconference notes were analysed using standard methods of thematic content analysis. A total of 45 individuals participated in interviews (n=24 persons in 38 interviews), teleconferences (n=32) or both (n=11).
RESULTS
Participants identified facilitators of the hospitals' success as: (1) the support of top institutional leaders, (2) heavy investments in educating physicians about the programme, (3) active cultivation of the relationship between hospital risk managers and representatives from the liability insurer, (4) the use of formal decision protocols, (5) effective oversight by full-time project managers, (6) collaborative group implementation, and (7) small institutional size.
CONCLUSION
Although not necessarily causal, several distinctive factors appear to be associated with successful CRP implementation.
Identifiants
pubmed: 31959716
pii: bmjqs-2019-010296
doi: 10.1136/bmjqs-2019-010296
pmc: PMC7590903
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Pagination
895-904Commentaires et corrections
Type : CommentIn
Informations de copyright
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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