Dignity Health Expands Use of AHRQ's CANDOR Toolkit

Dignity Health, one of the Nation's largest hospital systems, has expanded its use of AHRQ's Communication and Optimal Resolution (CANDOR) toolkit to 12 hospitals in California. The toolkit helps hospitals, health system leaders, and clinicians communicate accurately and openly with patients and their families when something goes wrong with their care.

Four Sacramento-area Dignity Health hospitals were among 14 hospitals nationwide that tested the CANDOR process. The health system, based in San Francisco, has since spread the CANDOR process to eight more hospitals as part of a planned 36-hospital, systemwide rollout.

"Our goal is to get with the patients and families within 60 minutes of an event," explained Linda Ubaldi, Dignity Health Greater Sacramento Service Area’s senior director of quality management, risk management, patient safety, and regulatory compliance. "All we know is an event has happened; we don’t know how or why. But we will work with the patient or their family."

Traditionally, hospitals and health care providers are not fully forthcoming with patients and families when harm occurs, and rarely before an investigation or judicial process concludes. The CANDOR process turns traditional thinking on its head, providing methods and tools for hospitals and health systems to respond immediately to harm while promoting candid, empathetic communication and timely resolution for patients and caregivers.

"The response has been very positive," Ms. Ubaldi noted, "among patients and families and among staff."

"The principles we follow are that patients and families have the right to know," said Barbara Pelletreau, R.N., M.P.H., Dignity Health’s senior vice president of patient safety. "In the past, we often waited until we had all the answers and had completed the Root Cause Analysis. Now, we communicate with patients and families right away." When hospitals stay silent, it only frustrates, angers, and raises the suspicions of patients and families, she noted.

Prior to implementing the CANDOR process as a test in September 2014, Dignity Health had an existing disclosure policy in place regarding harm. However, the CANDOR process gave those efforts "more structure and a framework," Ms. Pelletreau said. She added that CANDOR’s advanced training with clinical and non-clinical staff "helped us better communicate with families."

"We have a claims department that philosophically agrees with informing patients and families right away," she continued. Dignity Health also brings physicians into the process early "so they are part of the team." That's essential, "as physicians are trained not to say anything," she explained.

Following implementation of the CANDOR toolkit at several Dignity Health hospitals, claims teams were able to work with patients and families to resolve claims more quickly. Although it is too early to confirm that the amount of claims or awards was reduced, ample anecdotal evidence reveals that litigation decreased after the system implemented the toolkit.

After expanding the CANDOR process to 13 other hospitals in February 2017, Dignity Health will implement the toolkit in its remaining nine hospitals by the end of 2017. It takes 6 months to properly prepare and train a hospital’s leaders, clinical, and non-clinical staff and to adopt the CANDOR process, Ms. Pelletreau noted.