The Georgia CANDOR act: towards candid communication and effective resolution in healthcare

Despite the best efforts of healthcare professionals, there is always a chance that an accident or mistake could occur, be it due to a known complication of treatment, human error, or problem at the organization level. These adverse healthcare incidents can be dangerous and can lead to patient injury or even death.

Historically, whenever a patient suffers an adverse outcome, healthcare professionals have tended to assume a defensive stance on the matter and have been told to avoid telling the patient what happened. This is referred to as "deny, delay, and defend." For many years it had been a barrier to frank and truthful communication between healthcare professionals and patients. At its root, this problem stems from the fact that most healthcare institutions do not have a comprehensive and systematic approach for resolving unanticipated outcomes. This is where the "Communication and Optimal Resolution" (CANDOR) program comes into play.

The CANDOR program is a way for healthcare organizations and physicians to communicate and be accountable when something goes wrong with a patient's care. The program follows a set of steps, starting with the healthcare professional explaining to the patient and their family what happened, ideally as soon as possible, and how this will affect their care. Healthcare professionals then offer counseling or support services to the patient and their family as needed to help them cope with the effects of the incident. The facility also offers counseling to healthcare professionals whose patients experience a bad outcome. Meanwhile, the healthcare institution identifies and addresses the root causes of the incident and retraces all events leading to it. They keep the patient and their family updated on efforts to prevent similar problems from occurring in the future. The presence of additional people with the patient is also permitted during the CANDOR process.

In addition to accelerating the resolution process, it helps patients and healthcare providers to reach agreement on compensation when a patient experiences an unexpected bad outcome. "I was very, very surprised that the doctor wanted to meet with me. They more or less admitted they made a mistake. They did talk about how things were going to be changed and that it is something they don't want to keep continuing. I felt very, very good after leaving that meeting. I felt as though they understood how I felt…. The doctor was very kind and made me feel at ease, and that I did have a reason to be upset," says Patricia, a patient at Beth Israel Deaconess Medical Center.

Because of all these reasons, the CANDOR program helps healthcare organizations improve the quality and safety of their care, as well as enhance trust and confidence in the healthcare system. It would do away with the culture of 'deny and defend' and replace it with a culture of transparency, candid communication, and accountability for errors. In turn, this would lead to better intervention design and ultimately help in the prevention of similar incidents. In a 2013 TED Talk at TEDxUniversityofNevada, Leilani Schweitzer, who lost her son as a result of a medical error, highlighted how transparency and open communication help, "Unlike (the local hospital that practiced) Deny, (Delay), and Defend, they (the children's hospital) investigated, they explained, took responsibility, apologized, then asked what they could do… It made all the difference."

Adopting an open communication program like CANDOR also benefits hospitals. According to Andy Smith in "Beyond 'Denial and Defense,'" an article in the American Association of Physician Leadership Journal, "Health care organizations moving away from a defensive posture after medical error are reaping benefits. It makes more sense for them to adopt communication and resolution programs that emphasize just culture, patient safety, and physician wellness. The result is fewer malpractice-related expenses."

The Georgia CANDOR Act aims to provide secure avenues for patients and healthcare professionals to voluntarily interact and openly communicate. The meetings are confidential, creating an environment for open discussion. The patient is nonetheless encouraged to have legal counsel. They do not waive their right to withdraw from the Candor process and file a legal claim.

Similar CANDOR bills are quickly gaining traction across several US states. With any luck, the CANDOR program will become a standard option for patients and their families in the face of adverse medical incidents, as well as become a useful tool for healthcare institutions and physicians to improve the care of their patients.