Review of AHRQ's new "CANDOR" Disclosure Tool Kit

Recently, AHRQ -- the Agency for Healthcare Research and Quality -- released a comprehensive Disclosure Tool Kit for hospitals entitled "CANDOR," which is short for Communication and Optimal Resolution. In this column I will review the CANDOR Disclosure Tool Kit. There were many high-level professionals and well-known organizations involved in the development of the CANDOR Kit. These individuals and organizations are welcome to publish a response in this space to my comments below. I will gladly accept one more or letters from individuals or organizations involved in the development of the CANDOR Tool Kit. I will only edit for typos, missing words, misspells, etc. I can be reached at doug@sorryworks.net or 618-559-8168. I sincerely hope the CANDOR leaders will not only respond to my comments below, but also further educate Sorry Works! readers about their content and plans going forward. Sorry Works! Review of the CANDOR Disclosure Tool Kit.

1) Overall impression? The CANDOR Tool Kit is a valuable contribution to the disclosure movement. It is obvious that the CANDOR team spent a lot of time and effort developing this tool kit. Bravo! There is a lot of videos and valuable information. However, is the CANDOR Tool Kit the "be all end all" for organizations seeking to implement disclosure? No. You should seek out disclosure training content from other organizations. I wouldn't even call the kit or the entire CANDOR project "excellent," at least not yet. See my comments below.

2) Where is the publicity? The CANDOR team spent several years and presumably lots of government grant money developing this free tool kit, yet the launch of their kit has generated scant media coverage. According to my search of Google News, I've seen only four articles over the last three weeks, including a press release the CANDOR folks paid for PR Newswire to distribute. PR Newswire is like Twitter for reporters, and just like Twitter for us non-reporters, most reporters don't pay much attention to PR Newswire. The CANDOR Tool Kit and this entire CANDOR project has ZERO value if nobody knows about it.

Now, the CANDOR folks may say they are sending e-mails and letters to their colleagues, but a true PR push for a project of this magnitude should hit all the buttons, including popular and trade media outlets as well as social media -- especially social media. A true media plan would include personalized e-mails to reporters & bloggers followed up with phone calls to pitch the story and a list of people ready to go on the record. You got to sell it! It should have been a full-court press, and Sorry Works! should have been included in that effort. Yes, we sell our own content at Sorry Works!, but we have a history of promoting products and content developed by others. If it's good for disclosure, we will publicize it. Sorry Works! has an e-distribution list of over 2,000 healthcare, insurance, and legal professionals who are interested in disclosure and signed up for our e-newsletter voluntarily --- it's a very valuable list for disclosure advocates. The Sorry Works! website receives nearly 500 unique visits per day, and we have a healthy and growing presence in social media. So, if CANDOR or anyone else wants to share something about disclosure, you are welcome here. To help the CANDOR folks, here is the link to their Tool Kit. Moreover, CANDOR team members are welcome to write a column to educate Sorry Works! readers in this space...just send me an e-mail to doug@sorryworks.net or call 618-559-8168.

3) What about long-term care and assisted living? A nursing home administrator could be forgiven if he/she thought CANDOR had nothing to do with their industry. Maybe I missed it, but I did not see or read one mention of long-term care or assisted living in the CANDOR program. The kit seems specifically geared towards hospitals. Yet, we know that nursing homes have an ever increasing role in our healthcare delivery system, regularly share patients with hospitals, and have huge liability exposure. Speaking for Sorry Works!, we are spending more and more time with long-term care and assisted living professionals....they need and want disclosure training. In developing the Sorry Works! Tool Kit, we made sure the content covered both acute and long-term care, including cases and scenarios specific to long-term care. So, I hope going forward the CANDOR folks will address this major gap in their tool kit. Yes, there are some differences between long-term care and acute organizations, both in terminology (residents versus patients) and also the relationship with the families, BUT, when something goes wrong in a nursing home, hospital, or doctor's office, consumers want one thing: CANDOR!

4) Lot of good information in CANDOR, but maybe information overload and where is the story? Hats off to the CANDOR folks for putting a lot of information in their kit. CANDOR has plenty of bullet points, Power Point presentations, and plenty of videos, but the way it is presented may be a bit overwhelming for some healthcare, insurance, and legal professionals. The beauty of disclosure is that it is a relativity simple idea....be honest and contrite when something goes wrong. However, you have to balance this simplicity against the complexities of healthcare, the law, and insurance companies. It's a fine line to walk, yet to me, I feel the construction/layout of the CANDOR Tool Kit may overwhelm people, and I could see busy executives saying, "Wow, that's a lot, and we don't have time for this right now." To the eye, CANDOR looks like....a lot of bullet points and links. To me, disclosure (or any culture change operation) needs to start small, get a few people really excited, and let the fire grow out from there. From my viewpoint, CANDOR seems like dumping a whole bunch of wood on top of the kindling. Moreover, I don't see the story or storyline with CANDOR....again, from an artistic standpoint it comes across as too much text...kinda cold. It just doesn't feel or look right (my opinion). How content and ideas are presented is critically important (see the Apple Corporation as Exhibit A), and this is an area where CANDOR needs improvement going forward.

5) It's a heck of a public policy statement. Despite my criticisms, the development of the CANDOR Tool Kit is a heck of a public policy statement. It's not only a major contribution to the disclosure movement, it's also big breath of fresh air to the testosterone-charged debate over medical malpractice reform. The next time some lawyer, doctor, or insurance executive cries, "We need tort reform!" show them the CANDOR Tool Kit's promotional video. This film clip includes folks from the American Hospital Association, Physicians Insurers Association of America (PIAA), the Doctors' Company, and many other organizations who have historically supported tort reform. Now, I think we're all starting to see that the true "reform" to the medical malpractice crisis is disclosure and honesty.

So, what should you and your organization do? Review the CANDOR Tool Kit....learn from it...lots of good stuff there. Also, review other disclosure training content. Dr. Steve Kraman, the father of the disclosure movement, asked me to share this paper he wrote that will help many organizations develop their disclosure programs. The Institute for Healthcare Communication (formerly the Bayer Institute for Healthcare Communication) and Dr. Gerald Hickson at Vanderbilt have lots of great content and training tools. And, of course, there is Sorry Works!...check out our Sorry Works! Tool Kit. Seek out multiple perspectives and create your own disclosure program.

Also consider working with one or more consultants to help bring disclosure alive for your organization. Again, Sorry Works! (and other organizations too) can help with disclosure presentations and training...just give us a call at 618-559-8168 or e-mail doug@sorryworks.net.

Have a great weekend!