Challenges of Implementing a Communication-and-Resolution Program Where Multiple Organizations Must Cooperate.
OBJECTIVE
To implement a communication-and-resolution program (CRP) in a setting in which liability insurers and health care facilities must collaborate to resolve incidents involving a facility and separately insured clinicians.


METHODS
Six hospitals and clinics and a liability insurer in Washington State.


METHODS
Sites designed and implemented CRPs and contributed information about cases and operational challenges over 20 months. Data were qualitatively analyzed.


METHODS
Data from interviews with personnel responsible for CRP implementation were triangulated with data on program cases collected by sites and notes recorded during meetings with sites and among project team members.


RESULTS
Sites experienced small victories in resolving particular cases and streamlining some working relationships, but they were unable to successfully implement a collaborative CRP. Barriers included the insurer's distance from the point of care, passive rather than active support from top leaders, coordinating across departments and organizations, workload, nonparticipation by some physicians, and overcoming distrust.


CONCLUSIONS
Operating CRPs where multiple organizations must collaborate can be highly challenging. Success likely requires several preconditions, including preexisting trust among organizations, active leadership engagement, physicians' commitment to participate, mechanisms for quickly transmitting information to insurers, tolerance for missteps, and clear protocols for joint investigations and resolutions.
Stanford Law School, Stanford, CA.
Michelle M
MM
Mello
University of Washington School of Law, Seattle, WA.|University of Washington School of Nursing, Seattle, WA.
Sarah J
SJ
Armstrong
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA.
Yelena
Y
Greenberg
Physicians Insurance: A Mutual Company, Seattle, WA.
Patricia I
PI
McCotter
Division of General Internal Medicine, University of Washington, Seattle, WA.
Thomas H
TH
Gallagher
D003142:Communication; D003299:Cooperative Behavior; D006801:Humans; D007373:Interinstitutional Relations; D016365:Liability, Legal; D008318:Malpractice; D019300:Medical Errors; D017008:Negotiating / Q000379:methods; D016730:Program Development
Medical liability; communication; malpractice; medical error; patient safety