Patients visit healthcare organizations expecting to receive treatments or therapies that improve their health or offer relief from an illness.
While the vast majority of patients receive safe, effective care and experience positive outcomes, unexpected adverse events can and do occur despite the best intentions of highly skilled teams.
Consider a patient who undergoes what was expected to be a routine surgical procedure but sustains an unintended injury requiring additional surgery. Or a patient whose critical diagnostic test result was not communicated in a timely manner, resulting in a delayed diagnosis and treatment. In another situation, a medication error may lead to significant patient harm despite multiple safeguards intended to prevent it. These types of events often raise difficult questions for patients, families, clinicians, and organizational leaders alike.
How an organization responds in the hours and days following these events can profoundly impact patient trust, caregiver well-being, organizational culture, and future patient safety.
Communication and Resolution Programs (CRPs) provide a structured, clinically led framework for responding to significant adverse events. Rather than approaching these situations solely through the lens of liability or claims management, CRPs emphasize timely communication, compassionate support for patients and families, thorough investigation, organizational learning, and, when appropriate, accountability and resolution.
The goal is not simply to respond to an event; it is to strengthen transparency, reinforce a culture of safety, and use each event as an opportunity to improve care.
CRPs are not new. For more than two decades, healthcare organizations have used structured approaches to support open communication, event review, organizational learning, and, when appropriate, resolution following significant adverse events. The Agency for Healthcare Research and Quality (AHRQ) has been a leading advocate for CRPs, through its Communication and Optimal Resolution (CANDOR) toolkit, providing organizations with practical guidance and implementation resources.
CRPs involve clinical leadership, risk management, legal counsel, claims professionals, and other key stakeholders. Together, they develop a consistent approach to promptly communicating what happened to patients and their families, along with a plan to prevent similar occurrences in the future. At the same time, CRPs support caregivers and identify opportunities for healthcare organizations to improve care.
When should healthcare organizations consider activating a CRP?
Adverse events can trigger CRP activation. Broadly speaking, adverse events occur when a patient suffers harm from medical care aside from their underlying condition. Harm may range from temporary injury that requires additional treatment to permanent disability to death.
Organizations should consider initiating the CRP process when an unexpected patient outcome results in significant harm, raises questions about the care provided, or warrants a comprehensive review to understand what occurred. Early recognition allows clinical leaders to coordinate communication, support those involved, conduct a timely investigation, and determine the most appropriate path forward.
Healthcare organizations should adopt clear criteria for determining when to activate a formal CRP. Thresholds may vary, but CRPs are commonly considered for events involving:
Unexpected patient death.
Permanent or significant patient harm.
Serious safety or sentinel events.
Surgical, procedural, diagnostic, or medication-related events resulting in harm.
Wrong-patient, wrong-site, or wrong-procedure events.
Delayed diagnosis or treatment resulting in preventable harm.
Unanticipated complications that result in significant injury or prolonged hospitalization.
Events likely to generate substantial patient or family concern.
It’s important to note that neither an adverse event nor the activation of a CRP means that a caregiver committed an error or that the standard of care was not met. Rather, it initiates a structured process for communication, fact-finding, support, and organizational learning.
Are there times when a CRP is not typically activated?
Not every unexpected outcome requires activation of a formal CRP.
At one end of the spectrum, expected complications that occur in the course of appropriate care, minor events that cause little or no patient harm, near misses that do not reach the patient, or non-clinical concerns that can be managed through routine communication do not warrant a CRP.
In these circumstances, it is important to note that the decision not to activate a formal CRP does not diminish the need for timely, honest, and compassionate communication. Even when an outcome reflects a known risk of treatment or causes minimal harm, patients and families deserve clear explanations, opportunities to ask questions, and ongoing support.
On the other end, events involving suspected criminal conduct, abuse, practitioner impairment, or other circumstances requiring regulatory or law enforcement should be managed in close coordination with legal counsel, organizational leadership, and a professional liability insurer.
Elements of an effective CRP
CRPs may look slightly different, depending on the organization and the practice involved. But successful programs share a few common components. CRPs do not exist to arrive at quick conclusions, but rather to ensure a coordinated, compassionate, and consistent response to an adverse event while facts are gathered. At the same time, effective CRPs ensure that patients, families, and caregivers receive appropriate support.
While risk managers, legal counsel, and executive leadership play important roles in developing a response to an adverse event, successful CRPs are led by clinical leadership. This way, the response remains grounded in patient care, supported by a multidisciplinary team. Collaboration helps ensure that communication with patients and families is compassionate and clinically informative, while aligning with the organization’s commitment to safety and improvement.
Communicate
Communication should begin as soon as it learns of an adverse event or unexpected outcome. The initial conversation should, if appropriate, be led by the patient’s care team or clinical leaders who can explain the clinical circumstances and answer questions. Risk management, legal counsel, and other support functions should support these initial conversations rather than replace the clinical voice.
The first communication should:
Acknowledge what is known.
Express empathy.
Explain the immediate plan of care.
Outline next steps.
Patients and families should understand that the organization will carefully review the event and share information as it becomes available.
Prompt communication does not require that the organization know all the answers. Delaying conversations until an investigation concludes can erode trust. Organizations should communicate openly and consistently as additional facts emerge.
Investigate
An objective, multidisciplinary review should be initiated promptly to understand what occurred, identify contributing factors, and determine opportunities for improvement. Depending on the nature of the event, this may involve clinical leadership, patient safety, risk management, quality, legal counsel, and subject matter experts.
It’s not uncommon for those involved to have differing recollections or perspectives. An effective review seeks to reconcile available clinical documentation, interviews, and other evidence to develop an accurate understanding of the event. The purpose is to establish facts, not assign blame.
Support
Effective CRPs recognize that adverse events affect everyone involved. Patients and families deserve clear communication, compassion, and ongoing support. Clinicians and staff may also need resources to address the event’s emotional impact. Providing support helps foster trust, resilience, and a healthy patient culture.
Resolution
If a review determines that care contributed to patient harm, organizations should collaborate with patients, families, legal counsel, and professional liability partners to arrive at an appropriate resolution. That may include an explanation of findings, corrective actions, an apology when appropriate, or other measures consistent with organizational policies and professional liability considerations.
Learn
Adverse events present an opportunity to strengthen care delivery. Lessons learned should inform process improvements, education, policy refinement, and ongoing monitoring to reduce the likelihood of similar events occurring. A CRP’s value is measured not only by resolutions but also by an organization’s ability to translate individual events into lasting improvements.
Potential benefits of a successful CRP
Patient experience. Prompt and honest conversations build trust during difficult situations. Providing clear information, acknowledging concerns, and maintaining dialogue demonstrates an organization’s commitment to patients, their care, and transparency.
Patient safety. CRPs encourage organizations to identify system improvements. Reviewing events and following corrective actions results in a stronger patient safety culture and ongoing organizational improvement.
Workforce resilience. Adverse events affect both patients and caregivers. CRPs support caregivers while also reinforcing a culture that encourages reporting, learning, and continuous improvement.
Professional liability. CRPs are not claims management programs, but they complement broader risk management and professional liability strategies. A coordinated, transparent approach can help preserve relationships and align clinical, legal, claims, and risk management teams throughout the process.
Considerations for implementing a CRP
Organizations should establish consistent processes before an adverse event occurs, ensuring those responsible for responding understand their roles and are prepared to communicate effectively.
Organizations should consider the following:
Leadership and governance. Is there visible commitment from clinical and executive leadership to transparency, patient-centered communication, and organizational learning?
Clinical leadership. Are clinical leaders prepared to lead communication with patients and families, with support from patient safety, risk management, legal counsel, and other key stakeholders?
Policies and processes. Are there clearly defined criteria for activating a CRP, conducting event reviews, communicating with patients and families, and determining next steps?
Education and training. Have physicians, leaders, and staff received education on disclosure, empathetic communication, caregiver support, and their respective roles within the CRP process?
Multidisciplinary coordination. Are patient safety, quality, risk management, legal counsel, patient relations, claims professionals, clinical leadership, and executive leaders aligned in their approach and responsibilities?
Professional liability alignment. Does the organization’s professional liability insurer support the CRP approach, and are processes aligned for early reporting, engagement, and coordination when appropriate?
Continuous improvement. Are lessons learned translated into meaningful process improvements, education, policy updates, and ongoing evaluation to strengthen patient safety over time?
Why consider CRPs, and why now?
Patients and families expect timely, honest communications when something unexpected happens in a healthcare setting. Forthcoming initial discussions and continuous dialogue as information surfaces can build trust, while walling patients off can lead to frustration and mistrust.
Timely, coordinated, and compassionate communications can preserve relationships and de-escalate difficult circumstances, thereby complementing broader risk management and professional liability strategies.
CRPs reflect an organization’s commitment to safety, transparency, and accountability. They also demonstrate an organization’s willingness to learn from adverse events. CRPs support clinicians and staff involved, while also bolstering collaboration among clinical leadership, risk management, legal counsel, professional liability partners, and organizational leadership.
Lastly, national initiatives and evolving regulatory expectations continue to reinforce the importance of patient safety, organizational learning, and transparent communication, prompting many organizations to evaluate their event response processes.
Whether implemented through a formal CANDOR model or a broader communication and resolution strategy, CRPs reflect an important shift toward openness, learning, and trust.
Next steps
Healthcare organizations do not have to wait for an adverse event to evaluate their readiness. Now is the time to assess current response processes, align key stakeholders, and strengthen the systems that support timely communication, compassionate resolution, and meaningful organizational learning. Lockton’s Healthcare Practice can help organizations evaluate their CRP framework, identify gaps, and build a coordinated approach that supports patients, caregivers, and long-term resilience. For more information, contact us at HCRiskControl@lockton.com.