title: Disclosure, apology, and offer programs: stakeholders' views of barriers to and strategies for broad implementation.
abstract: BACKGROUND
  The Disclosure, Apology, and Offer (DA&O) model, a response to patient injuries caused by medical care, is an innovative approach receiving national attention for its early success as an alternative to the existing inherently adversarial, inefficient, and inequitable medical liability system. Examples of DA&O programs, however, are few.
  
  
  METHODS
  Through key informant interviews, we investigated the potential for more widespread implementation of this model by provider organizations and liability insurers, defining barriers to implementation and strategies for overcoming them. Our study focused on Massachusetts, but we also explored themes that are broadly generalizable to other states.
  
  
  RESULTS
  We found strong support for the DA&O model among key stakeholders, who cited its benefits for both the liability system and patient safety. The respondents did not perceive any insurmountable barriers to broad implementation, and they identified strategies that could be pursued relatively quickly. Such solutions would permit a range of organizations to implement the model without legislative hurdles.
  
  
  CONCLUSIONS
  Although more data are needed about the outcomes of DA&O programs, the model holds considerable promise for transforming the current approach to medical liability and patient safety.
authors.affiliation: Beth Israel Deaconess Medical Center of Harvard Medical School, Boston, MA 02215, USA.sbell1@bidmc.harvard.edu
authors.forename: Sigall K
authors.initials: SK
authors.lastname: Bell
authors.forename: Peter B
authors.initials: PB
authors.lastname: Smulowitz
authors.forename: Alan C
authors.initials: AC
authors.lastname: Woodward
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Mello
authors.forename: Anjali Mitter
authors.initials: AM
authors.lastname: Duva
authors.forename: Richard C
authors.initials: RC
authors.lastname: Boothman
authors.forename: Kenneth
authors.initials: K
authors.lastname: Sands
mesh_terms: D001291:Attitude of Health Personnel; D017598:Efficiency, Organizational; D006284:Health Plan Implementation / Q000379:methods*; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D016365:Liability, Legal; D008318:Malpractice; D019300:Medical Errors / Q000517:prevention & control*; D017146:Models, Organizational; D009936:Organizational Innovation; D011369:Professional-Patient Relations; D019984:Quality Indicators, Health Care; D012941:Social Responsibility; D014342:Truth Disclosure; D014481:United States