Interviews with Disclosure & Apology Leaders: DR. FLORENCE LECRAW

This year we are starting a series of interviews with leaders in the disclosure and apology movement.  Every month we will interview a different leader and share the responses via this e-newsletter, our blog, and social media. We hope you, our readers, enjoy this important content. 

We are starting our interview series with Dr. Florence LeCraw of Atlanta, Georgia.  Two years ago, Dr. LeCraw and her team published a ground-breaking paper that evaluated the efficacy of disclosure and apology in an "open" medical system with non-employed physicians covered by separate insurance policies.  It's a terrific and important paper.  If you haven't read the paper, I encourage you to do so.  Dr. LeCraw's responses to our questions below are equally important.  

One note: There is some different terminology in the disclosure movement...we at Sorry Works! say "disclosure," "disclosure and apology," or "disclosure programs."  Many published papers also use the same terminology.  Dr. LeCraw and others frequently use the term "CRP," which stands for "Communication and Resolution Program."  The different terms mean the same thing: Disclosure program = CRP and vice versa.  I just want to be sure there is no confusion with our readers. 
 
Enjoy Dr. LeCraw's comments immediately below!

Cheers,

- Doug

Sorry Works!: Two years ago, you wrote a ground-breaking paper, "Changes in liability clams, costs, and resolution times following the introduction of a communication-and-resolution program in Tennessee."  This was the first big study showing the potential of disclosure/CRP in an "open" setting with non-employed docs.  What has been the reaction to that paper?  How has that paper impacted the disclosure/CRP movement? 
 
Dr. LeCraw: There has been a very favorable reaction to this paper. Three papers investigated the impact of CRP on liability outcomes in different types of hospitals. Our paper was the third paper. It supported the finding of the first two studies. Many organizations wanted to see the results of the first two papers confirmed by a third paper. It appears that our third paper was the “critical mass” for the successful endorsement by local, state, and national organizations. The composite of these studies found no worsening of liability outcomes and evidence of improved liability outcomes. These liability outcomes included resolving cases quicker so patients can receive compensation sooner if a medical error results in injury, lower defense costs so more money goes to patients instead of attorneys, and an increased in the incidence of resolving a case with the hospital so a patient and their family do not have to pursue expensive, lengthy, and stressful litigation.
 
To advance this new policy required several teams focusing on the different organizations that we were seeking to endorse the program. It was a collaborative effort by physicians, health economists, health lawyers, patient advocate groups, hospital administrators and others. It has been rewarding to be on some of the teams.
 
At the national level: Our study was the impetus for the American Medical Association (AMA) in 2017 and the American Society of Anesthesiologists (ASA) Committee on Well-Being in 2019 to endorse CRP. The ASA is planning to educate their members on the benefits of CRP soon.
 
At the state level: In May 2019 the Colorado State Legislature passed a law known as the Colorado CANDOR Act by unanimous vote. This law makes it easier for Colorado healthcare systems and providers to implement CRP if they desire. CANDOR stands for Communication and Optimal Resolution. CANDOR is a type of CRP. During the Colorado Senate Judiciary Committee hearing, an opponent to CRP gave incorrect information about CRP. He misread a State Apology Law study that was published just prior to the Committee hearing. He stated that CRP worsened liability outcomes. In testimony before the Committee, a proponent for the bill, Jean Martin, MD, JD gave a copy of our paper to each Committee member that demonstrated his statement was not true.
 
At the local level: WellStar Healthcare System, the largest healthcare system in Georgia, announced in 2019 that they plan to implement CRP due to the results of our study confirming the results of the two previous studies.
 
Sorry Works!: Can you tell us about new research programs you are involved with or are planning? 

Dr. LeCraw: People who practice CRP have told us that one of the best benefits of CRP is that it lowers the anxiety and stress that the patient, their family, physicians, and other healthcare providers experience after an unexpected bad outcome occurs. We are working with a large healthcare system to see if what the front liners are telling us is correct. We also have a follow up study regarding the impact of CRP at Erlanger Healthcare System using more robust methodology. This investigation will allow us to be more conclusive about the effects of CRP on liability outcomes. This second study compares Erlanger’s liability outcomes with the state of Tennessee’s liability outcomes. This is opposed to the previous studies. They compared the liability outcomes at the healthcare system before and after they implemented CRP.  
 
Sorry Works!: What are your feelings about the future of the disclosure/CPR movement?  What are your hopes?  Where do you see the challenges? 
 
Dr. LeCraw: The Collaborative for Accountability and Improvement was established in 2015 to help advance CRP in the U.S. The significant progress they and others have made to implement CRP in the U.S. is exciting. Groups from other states who want to pass a law similar to Colorado and other countries have asked for advice and help from CRP leaders. The benefits of CRP to patients, their families, future patients, and healthcare providers, who have been impacted negatively by the current system known as “deny and defend”, is the reason for the success of the CRP movement. The challenge is educating people about CRP. They need to understand the advantages of CRP in order to adopt this new program. There are many wonderful people who are involved in educating people and policy leaders about CRP. They have committed much time and effort to this endeavor. It is an honor to work with them.