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MedStar Health, a large health system in the Baltimore, MD/Washington, DC, metropolitan area, reduced serious patient safety events by about 65 percent and reduced the cost of care associated with serious safety events (including medical liability payments) by more than $70 million since 2012. It achieved these successes by implementing a comprehensive patient safety program that included objectives such as high reliability, human factors, and patient and family partnerships, as well as principles and strategies from AHRQ's Communication and Optimal Resolution (CANDOR) toolkit.

The CANDOR toolkit provides methods and tools for hospitals and health systems to respond immediately when patients are unintentionally harmed by the medical care they receive. Despite the best efforts of doctors, nurses, and other health care professionals, research shows about 1 in 10 patients is harmed by medical care.

The CANDOR process emphasizes the importance of reporting unanticipated patient harm events as soon as they occur. By learning from those events and engaging in candid, empathetic communication with patients and families, hospitals can provide a timely resolution for patients and families and make sustainable changes in care models to prevent similar events from happening in the future.

David Mayer, M.D., MedStar Health's vice president of quality and safety, said the CANDOR program has been a significant component helping to contribute to reductions in serious safety events and malpractice claims.

"When a serious safety event occurs, our goal is to respond as quickly as possible using a 'Go Team' approach similar to [that of] the National Transportation Safety Board. We activate three teams: (1) a discovery and learning team, (2) a care for the caregiver team, and (3) a patient and family communication team. Our philosophy is to help patients and families affected by these events by responding to them immediately, gathering information to be able to answer all of their questions about the possible preventable harm that occurred, and then moving on to bring about a just and equitable resolution of the situation. We have learned through the years it's not only the right thing to do, it's the smart thing to do."

Mayer said the CANDOR program has led to greater transparency at MedStar Health because more employees through the years have been willing to report patient safety events without fear of retribution.

"The CANDOR process has raised the bar in terms of doing what’s best to help the patient," Mayer said. "With increased reporting and learning from these events when they occur, we can improve our systems and processes, without blaming people when unintentional mistakes do happen."

"We've also found that the implementation of the 'Care for the Caregiver' component of the CANDOR process contributes to improved employee morale and greater joy and meaning in the workplace."

MedStar Health, with 10 hospitals and 300 outpatient clinics, promotes CANDOR process workshops and continuous training for its 31,000-member workforce and 4,700 affiliated physicians. "We've trained our entire workforce on high-reliability tools and techniques, including board members," Mayer said.

Tim McDonald, M.D., J.D., director of MedStar Health's Center for Open and Honest Communication, said the CANDOR process enables healthcare organizations to successfully resolve patient safety errors without patients and families having to endure a burdensome, drawn-out legal process.

He explained, "With the CANDOR process, we're in the position to hold ourselves accountable and 'own' the patient safety issue. We hope to resolve the situation completely, using the legal system only as a last resort."