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Reflections on Safety is a monthly column presenting the insights of Tejal K. Gandhi, MD, MPH, CPPS, Chief Clinical and Safety Officer, Institute for Healthcare Improvement (IHI). Dr. Gandhi was president and CEO of the National Patient Safety Foundation prior to its merger with IHI in May 2017.


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Using CANDOR to Improve Communication and Resolution in Health Care

Posted By Administration, Friday, July 15, 2016
Updated: Friday, July 15, 2016
A customizable resource from the Agency for Healthcare Research and Quality

helps facilitate vital conversations.

By Tejal K. Gandhi, MD, MPH, CPPS

Tejal K. Gandhi

A cornerstone of the National Patient Safety Foundation’s work involves a push for greater transparency in health care. The NPSF Lucian Leape Institute report on this topic outlines four domains where greater transparency can lead to safer care: between clinicians and patients, among clinicians, between organizations, and with the public.

At its core, transparency between clinicians and patients would demand disclosing medical errors and doing the right thing to mitigate harm when it occurs. Some health systems, such as the University of Michigan Health System, have long recognized that such practices bring benefits for all parties. Patients and families receive an explanation and understanding of what went wrong and why; clinicians involved are permitted to apologize if a mistake was made and to help patients and families heal; and the organization often benefits, because when errors are brought out into the open, solutions can be effected that prevent them from happening again.

Often called Communication and Resolution Programs (CRPs), these efforts get to an essential fact: That most patients and families do not want to punish or sue a hospital, provider, or health system. They simply want to know what happened and that the hospital and clinicians are taking steps to make sure it does not happen again to another patient or family. Financial compensation is also a part of these programs, because it is often necessary support for patients and families after a preventable event.

NPSF has partnered with the Collaborative for Accountability and Improvement to create an educational program for those interested in learning how to implement a CRP in their organization. The program was offered as a full-day immersion workshop at the NPSF Congress in May (read more about that program here).

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If you missed the complimentary
NPSF webcast,
Implementing an
Effective Communication and
Resolution Program,
listen to the replay.


During the session, Erin Grace, MHA, of the Agency for Healthcare Research and Quality (AHRQ) presented details of a new resource to help clinicians and health systems that want
to set up their own CRP. The AHRQ-developed communication and resolution process, called Communication and Optimal Resolution, or CANDOR, gives hospitals and health systems the tools to respond immediately when a patient is harmed and to promote candid, empathetic communication
and timely resolution for patients and caregivers.

“The CANDOR process is a proactive approach that health care institutions and practitioners can use to respond in a timely, thorough, and just way to unexpected patient harm events,” Ms. Grace said.

Apologizing for errors or bad outcomes runs counter to the culture in which many health care professionals and administrators have long worked. A big fear among many health and risk management professionals is that medical malpractice claims will go up in an institution that readily admits to error. But at the University of Michigan, for example, that has not been the case.

Rick Boothman, JD, chief risk officer at University of Michigan, a long-serving member of the NPSF Board of Directors, and a leading voice at the national level for CRP programs, has spoken often about his organization’s experience. At University of Michigan, since the start of the “Michigan Model” of communication and resolution, malpractice claims have decreased, along with malpractice payments.

Says Mr. Boothman, “At its heart, CANDOR is aimed at stimulating patient safety and optimal patient care…It is only through honesty that we can identify our problems and improve. By focusing on safety improvement, the claims crisis will take care of itself.”

I encourage health professionals—and especially leaders of health care organizations—to take the time to review the CANDOR Toolkit and consider putting it into action.

Does your organization have a formal program for communication around medical errors? Comment on this post below. Note: To comment, you must first register on the website. If you are already registered, you must log in to comment.

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Tejal K. Gandhi, MD, MPH, CPPS, is president and chief executive officer of the National Patient Safety Foundation and of the NPSF Lucian Leape Institute.

Tags:  AHRQ  communication and resolution  CRP 

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