The “Michigan Model” originated in 2001 when Richard Boothman, chief risk officer at University of Michigan Health (UM), created a systematic process for disclosing medical errors. Due to its success, it became a model for hospitals across the country, and Boothman became the nation’s foremost promoter of disclosure programs. Over the course of the next two decades, the Michigan Model evolved into what is now known as a communication and resolution program, or CRP.
Boothman also claims that with transparency at the core of CRPs, they serve to protect the patient. And yet, my research indicates that rather than being transparent, these programs are hidden from their patients — which raises the question, why?
My journey into researching CRPs began because of a wrong-site medical error; instead of removing a tiny, benign brain tumor, UM’s star neurosurgeon removed most of my healthy pituitary gland. Yet UM did not disclose the error. Equally troubling is that they did not disclose that they had a disclosure program. It was only years later, when a friend sent me an article about CRPs, that I discovered that they had one.
In retrospect, I believe it was largely UM’s lack of transparency and accountability that prevented me from being able to move on, eventually leading me to tell my story online and invite other harmed patients to share theirs. I wanted to know whether my experience at UM was an outlier, or if it was part of a wider pattern. Twenty-nine patients responded with heart-wrenching stories about medical errors — yet not one knew whether their hospital had a CRP. I found this so incredible that I called their hospitals and asked them directly if they had a disclosure-type program. I was told that they were unsure, they didn’t have time to talk, they felt uncomfortable talking about it, or that they weren’t authorised to answer that question.
Dissatisfied, I hunted through dozens of newspaper articles about disclosure programs and found that, while hospitals often hide their CRP’s from their patients, they tend to be forthright with journalists. This enabled me to identify 33 hospitals with documented CRPs. But when I checked those hospital’s websites, I discovered that information about their program, if provided, was tricky to find: patients searching the website would need to know specific key words or acronyms (“CRP” being one). In effect, to learn about the program, patients would have to already know that it exists.
Although patients commonly receive a booklet or leaflet of important information from their hospital, these typically omit any mention of the hospital’s CRP. Instead, patients are informed about the program using a two-step procedure: first, an error is flagged by hospital staff; and, second, the patient is told about the error and that the hospital has a CRP.
While this two-step procedure may be effective when an error is flagged, it’s inadequate as a general approach because even the best-intentioned hospital can’t detect all errors. This means that when a hospital fails to note an error, the harmed patient remains in the dark about their hospital’s CRP, and is unable to get the answers and support these programs promise. Also concerning, is that because these patients don’t know about the CRP, they are unlikely to inform the hospital of their first-hand experiences — often crucial to revealing undetected errors — and the opportunity to learn from these errors is impaired or lost entirely.
Since I had always assumed that UM’s failure to inform me about its CRP was an anomaly, I was surprised when my research showed it to be a common theme. I see it as a critical flaw in the program’s design because it leaves hospitals free to select which errors they will disclose, and which they will not.
The practice of selective disclosure allows errors that are likely to trigger lawsuits or be especially costly (for example, those involving clear negligence or the most serious harms) to be hidden. As all risk managers would know, a prestigious Harvard study determined that less than 2% of injured patients actually sue. Further research found that one common cause for the strikingly low percentage of patients who file claims, is ignorance — most medical error victims fail to realize that they have received negligent care. It seems clear to me that by concealing their CRPs, hospitals can avoid alerting their unsuspecting patients to the possibility of malpractice — and by doing so, they can protect their bottom line.
A potential solution: since it’s not enough to share CRP information only with selected patients, and only after the hospital has determined that a medical error has occurred, it may be necessary to involve The Joint Commission. Currently they require hospitals to disclose all unanticipated outcomes to their patients. By requiring that they also provide all patients with an information publication that includes a brief introduction to the hospital’s CRP, and a link to their website with further details, no patient will be left in the dark.