In May of 2016, the Communication and Optimal Resolution (CANDOR) toolkit was released by Medstar under the direction of the Agency for Healthcare Research and Quality. The toolkit contains power points, videos and other resources to help participating hospitals communicate and resolve medical errors with patients and their families. While such an initiative comes as no surprise as the next logical step to compliment patient and family-centered care, it is of little consolation to patients who are seeking information about their loved ones from hospitals that continue to practice deny and defend strategies in order to avoid accountability for medical error. In order for this new initiative to be successful, Communication and Optimal Resolution (CANDOR) needs regulatory oversight.
Although the principles of CANDOR are sound, the shortcoming that undermines its success is voluntary participation in the program. No oversight of the implementation of CANDOR’s basic principles is equivalent to no accountability. Hospitals may report that they are participating in CANDOR, but in fact, they may be actively practicing deny and defend strategies when it comes to conflict resolution. Health care institutions may choose to settle a case outside of court when, due to the grievous nature of the case, it would not have been advantageous for them to settle it in front of a jury. In other words, hospitals could elect to practice the principles of CANDOR only for those cases that they would have lost in court anyway. Some cases are so egregious that hospitals prefer to settle them outside of the courtroom to avoid paying out larger settlements and receiving unwanted negative publicity.
But how can patients identify which hospitals are participating in CANDOR, and as such, may be inherently safer, as opposed to those who do not? Without accountability and oversight, any hospital can claim to be participating in CANDOR, when in fact, they may only use it for those cases that meet specific criteria. In order for patients to asses the probability of whether or not their chosen hospital carries a good safety record independent of their stance on CANDOR, there are several measures on which they can rely. In any state in the union, with the exception of Maryland, patients can check their hospital’s safety score. Patients can check their state’s hospital safety scores before committing to a high risk procedure, and they may also obtain data from government agencies that keep track of hospital errors and adverse events through the Freedom of Information Act. However, some data collected remains confidential, and patients will need to contact their Department of Health and Human Resources for specifics on what types of data are available.
Another safety measure that patients can review before choosing a hospital is the nurse staffing to patient ratio at the hospital in which they wish to seek care. When financial budgets are stretched, administrators will sometimes try to control costs by reducing the number of caregivers on duty that may require nurses and doctors to take on unsafe patient loads that may result in a less than optimal patient to caregiver staffing ratio. In general, an ICU nurse should not have more than two ICU admissions at any given time, and floor nurses should not be in charge of more than six patients at any given time during the day shift hours. Evening and night shifts can safely carry slightly higher patient loads. Of course, there are situations that may arise to temporarily increase patient load that may be unavoidable, but if a hospital has higher than the recommended staffing ratios across the board, then it may be indicative of compromised patient safety.
In implementing CANDOR, hospitals need to develop policies and plans to address the informational needs of all patients—not just those who qualify for a financial settlement. Patients that have experienced harm report that the typical deny and defend strategy that has been in place for decades leaves them no other option but to conclude that hospital administrators and risk management officers have little or no interest in the harm that they or their loved ones have experienced. In their failure to be transparent, administrators further demonstrate their willingness to allow the same errors to occur to other patients rather than address the problems that allowed the harm to occur. Patients report that the refusal to acknowledge the medical error is to deny the suffering of the patient and family, and as such prevent the healing that would result from eliminating the same error from happening to other patients and their families. The emotional damage that patients and their families suffer from the failure to honestly disclose errors can be lifelong.
The advent of the CANDOR toolkit would greatly impact patient care if hospitals would buy-in and integrate its principles into the culture of medicine. However, the toolkit was designed for full implementation in order to make a difference in patient care—not partial implementation. One video included in the kit demonstrates an acceptable approach that a risk management officer may elect to utilize when offering monetary compensation to an injured party for damages. Providing compensation in this manner would incur the vehement objection of every hospital legal team in the country that currently relies on standard deny and defend strategies. The deviation from the norm is just too great. Short of an act of Congress, implementation of all components of CANDOR will not be something that voluntarily occurs in health care institutions across the country.
Hospitals that do not voluntarily participate in CANDOR, or who only participate when it is convenient for them may be ultimately orchestrating their own demise. The culture of medicine is changing, and health care institutions who try to hold on to archaic practices will have a hard road ahead. Patients are becoming more savvy about their health care and about their expectations from health care professionals. Perhaps in the not so distant future, the implementation of CANDOR will become a mandatory practice. The Agency for Healthcare Research and Quality did not spend twenty-three million dollars to watch CANDOR self-destruct. Institutions who continue to place their bottom line before patient safety and human suffering will never be recognized as one that delivers optimal patient and family-centered care. If patient-centered care is the new norm, how will hospitals entrenched in deny and defend strategies pull themselves out of the muck in time to start practicing the polar opposite? It may take an act of Congress after all. It’s something to think about, and the answer may be just around the corner.
Originally posted 2016-10-21 22:50:48. Republished by Blog Post Promoter