Programs for responding after patients are harmed by their healthcare: A Making Healthcare Safer IV rapid review

Abstract

Background: Patient harm from healthcare is prevalent, serious, and can be long lasting. How healthcare organizations respond has implications for patients, families, healthcare professionals, and organizations. We sought to synthesize the evidence on the effectiveness of communication and resolution programs (CRPs). Methods: Harm response programs that incorporated communication with patients and families, event review, quality improvement, and in a qualifying subset of events, an apology and an offer of compensation were included. We searched PubMed and the Cochrane Library for systematic reviews and primary studies published from 1 January 2010 to November 2025, supplemented by a review of gray literature. Results: We retrieved 2801 citations, of which nine primary studies and no systematic reviews were identified as eligible. The studies focused on medical malpractice experience and financial outcomes. The most robust CRPs reduced the rate of claims, and defense legal fees and expenses (strength of evidence: low). Time to resolution, rate of lawsuits, overall costs to healthcare organizations, and settlement amounts decreased or had no significant change. Evidence was lacking or limited for CRPs’ effects on: other aspects of patient, family, or clinician outcomes or experience; patient safety; quality of care; communication and relationships between patients, families, and organizations; and interprofessional communication. Conclusions: CRP implementation is supported by evidence of positive or neutral effects on organizational liability and cost outcomes, but more research is needed to determine the effects on patient, family, and clinician-oriented outcomes.