A Quiet Revolution: Communicating and Resolving Patient Harm

  • William M. Sage
  • Madelene J. Ottosen
  • Ben Coopwood


Good patient care includes not only avoiding error and injury but also acting honestly and constructively should it occur. Communication and Resolution Programs (CRPs) commit the sponsoring institution to vigilant detection of error, full disclosure to patients and families, and timely redress. CRPs also seek to incorporate the perspectives of patients and family members into safety improvement activities. This chapter explains the principles underlying CRPs, traces their history, and describes current best practices for physicians, provider organizations, and the legal and regulatory environment. Transparency about error and proactive response to injury lagged other professional commitments to patient self-determination because of the emotion and politics surrounding medical malpractice. However, recent generations of physicians, patients, and policymakers have engineered a “quiet” revolution. Silence and secrecy are no longer ethically acceptable responses to medical error. Although additional research is needed on how CRPs affect safety, patient and provider satisfaction, and cost, the American College of Surgeons in 2014 declared CRPs to be, on balance, the most promising approach to medical liability reform.


Communication and resolution Medical error Malpractice Patient safety Disclosure Transparency 



The authors thank medical student Adam Hensley, University of Texas Medical Branch, for research assistance. The authors extend special thanks to Dr. Tom Gallagher at the University of Washington for providing detailed, current information about CRP initiatives nationwide.


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • William M. Sage
    • 1
  • Madelene J. Ottosen
    • 2
  • Ben Coopwood
    • 3
  1. 1.School of Law and Dell Medical School, University of Texas at AustinAustinUSA
  2. 2.Department of Family HealthUTHealth-Memorial Hermann Center for Healthcare Quality and SafetyHoustonUSA
  3. 3.Department of Surgery and Perioperative Care, Dell Medical SchoolUniversity of Texas at AustinAustinUSA

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