Outcomes of Michigan Medicine's integrated patient safety and communication and resolution program, 2013–2022

Background Whether to manage malpractice claims by a proactive communication and resolution program or by the traditional adversarial legal process remains an important but unsettled question in health care risk management and the long-term durability of a communication and resolution program is unknown. We report here on the current outcomes of the Michigan Medicine communication and resolution program after 20 years in operation. Methods Deidentified data from the Michigan Medicine claims database for fiscal years 2013 through 2022 were analyzed to delineate the processes and outcomes of the Michigan Medicine communication and resolution program. Results During the period of study, patient safety event reports increased by 37.5% while the proportion of events associated with harm fell from 10.5% to 6.7%. The Clinical Care Review Committee, a multidisciplinary medical staff quality and safety oversight panel, deemed care reasonable in 638 of 989 claims (65%), guiding communication and resolution program discussions. 564 (88%) of these were closed or dismissed without payment. 288 (83%) of the 349 cases in which care was deemed unreasonable were settled. The rate of liability claims remained stable at 3.8/100,000 exposures per month. The median time to resolve claims was 11 months. Conclusions Analysis of the most recent 10 years of Michigan Medicine's communication and resolution program activity confirms that the program is well-integrated into its system-wide patient safety program and that its early success has proven durable. It also illustrates the benefits of integrating multidisciplinary quality review and improvement into a communication and resolution program. It may serve as a model for other health care systems.