Early on in his career, Dr. Tim McDonald, MD, JD, realized the healthcare system’s approach to handling patient harm, events, and mistakes was all wrong. Barriers within the health and legal system closed off any chance for complete transparency and openness between patients and their care. This experience led to a growing fascination and interest with the law, specifically in the realm of medical liability. McDonald knew that having a medical degree while working towards a law degree would later come full-circle and he would be involved in many important issues.
At the University of Illinois, during his early work in patient safety, McDonald worked with many national experts to help shift the system’s approach to patient harm. One of these experts included Rick Boothman, a former trial attorney, who left a busy malpractice defense law practice in Michigan and Ohio to establish a new approach and process for unanticipated patient outcomes at the University of Michigan – a process that became known as the Michigan Model.
With Boothman’s guidance, McDonald and his team, including Dave Mayer – a member of the Patient Safety Movement Foundation (PSMF) Board of Directors, spent a year and a half redesigning how patient harm was handled at the University of Illinois, improving the quality of care while mitigating medical liability issues and produced The Seven Pillars Program – a precursor to a later process which would be called, Communication and Optimal Resolution (CANDOR).
The Seven Pillars Program and its transparent approach for patient harm events could be adopted through the implementation of seven principles: 1) Teaching, 2) Reporting the event, 3) Investigation whilst supporting the involved caregiver, 4) Communication with the patient and family, 5) Caring for the patient and family through apology & resolution, financial when appropriate, 6) Fully understanding what happened and linking it back to process improvements, and 7) Data collecting and tracking.
In the first two years, following the launch and implementation of the program, 200 system improvements were reported and Illinois, like Michigan, did not experience the predicted financial Armageddon when they were open and honest with patients and families. The gain of these results garnered both national and international attention and led to funding from the Agency for Healthcare Research & Quality (AHRQ) for McDonald and his colleagues to pursue further studying and research to improve patient safety and reduce liability. AHRQ’s federal funding and medical liability grant initiative ultimately aided in the creation of the CANDOR toolkit as well as the pilot work and process testing conducted at three U.S. health systems: MedStar Health, Christiana Care, and Dignity Health.
McDonald has since joined MedStar as their Director in the Center for Open and Honest Communication within the MedStar Institute for Quality and Safety.
The CANDOR Toolkit and process is a whole system approach on how to deal with catastrophic events
“Delay, Deny & Defend” the inerrant and classic response taken by healthcare institutions when a patient suffers from negligent treatment is being braved by a movement defined by transparency and disclosure. Communication, which, ideally begins within the 60-minutes following a CANDOR event. A CANDOR event is defined as being any event that involves unexpected physical, emotional, or financial harm to a patient, is the third component within CANDOR’s five step process. The communication process with the patient and/or family then continues as the organization analyzes the event and learns more about what happened and why until there is a final resolution. If care is deemed inappropriate, that resolution may include financial compensation and, most importantly, a commitment to improve and prevent future such occurrences.
The CANDOR process improves patient safety, communication and better serves all involved in healthcare, through a compassionate and objective approach following harm events and medical errors. The process promotes a culture focused on love through truly caring for the patient, family and caregiver and has been proven to increase the amount of organizational learning and improvement, decrease the number of times patients sue their doctor and hospital, decreasing the amount spent on legal fees, and above all, improving transparency across the organization at large and less suffering for both patients and families as well as healthcare workers.
Patient safety cannot improve without an open and honest approach to patient harm
McDonald is already working with over 100 hospitals who have or are in the process of implementing CANDOR and early, open and honest communication policies. His goal in the next decade is to help as many hospitals, health systems and physician’s practices as possible roll out the CANDOR process and with the help and partnership of the PSMF the hope is that the number will continue to increase.