Michigan Model

The “Michigan Model” for Responding to Medical Errors

The University of Michigan medical system, Michigan Medicine, is a pioneer in reforming hospitals’ responses to patient harm. Read more about the “Michigan Model” and how it has impacted policies across the country.


What Is the Michigan Model for Responding to Medical Malpractice?

When patients are harmed during treatment, medical professionals are often reluctant to openly discuss what went wrong. In a post on the University of Michigan Health Lab Blog, Kara Gavin calls this an “invisible wall of silence — built out of legal worries.” She goes onto explain that this wall prevents patients and their families from getting answers, and also prohibits medical professionals from learning from their mistakes (1).

Michigan Medicine worked to break down this wall. In 2004, they changed their protocol for responding to patient concerns and potential malpractice suits. Previously, they would essentially wait until a claim was filed and then proceed to litigation. Under the new management model, Michigan Medicine emphasizes communication, full disclosure, and learning from their mistakes.

When a patient complains or a staff member reports an accident or near miss, they begin a dialogue with the patient in question and/or his or her medical representative (hereafter, for simplicity’s sake, “the patient”). If the administration agrees that care was unreasonable, they offer an apology and in some cases, financial compensation. If they believe no malpractice occurred, then both providers and the patient attempt to explain their sides of the story before formal legal action is taken.

What Is the Broader Impact of the Michigan Model?Michigan Model

The new system has resulted in much fewer medical malpractice suits filed against Michigan Medicine, as well as reduced time spent handling claims.

As Michigan Medicine’s website notes, “…if there is to be any major reduction in medical malpractice claims and the financial impact they have on the medical community, there must first be an integrated approach to patient safety, quality improvement and the education of both medical staff and patients.”

Since its inception in 2004, the “Michigan Model” has impacted hospital policies throughout the nation. In 2016, the Agency for Healthcare Research and Quality (AHRQ) introduced a free resource for hospitals called the CANDOR Toolkit (3), which can help them adopt a system based in part on the University of Michigan’s system. The toolkit includes powerpoint presentations, notes, videos, and worksheets. It consists of eight modules, detailing best practices for responding to patient concerns or potential harm. Much like the Michigan Model, the CANDOR process stresses the importance of providing emotional support to patients and families, maintaining communication, learning to prevent similar events from occurring in the future, and explaining to the patient what will be done to avoid repeat mistakes. So far, it has been implemented in 14 hospitals and three different health systems: Christiana Care in Delaware, Dignity Health in California, and MedStar Health in the Baltimore/Washington, D.C., metropolitan area (4).

In a video overview (5) of the CANDOR process, a woman named Carole Hemmelgram reflects on losing her daughter to a hospital-borne infection in an institution with a much less open response to catastrophe. “The organization where she died shut down on me,” she says. “They would not talk about what happened. They would not give me her medical records. It took the organization where she died three years, seven months, and 28 days to have a conversation with me.”

The video shows that medical professionals can also be emotionally affected by pressure to maintain the “wall of silence.” Interviewee Dr. Heather Farley discusses the events that led up to her facing a lawsuit. She had discharged a patient prematurely, and only realized the mistake when the patient was readmitted to the ICU, having gone into cardiac arrest and been resuscitated. Dr. Farley felt terrible and immediately wanted to go talk to the patient’s family. However, many of her colleagues strongly advised against it. “I just wanted to tell them what I knew,” she says. “Cause I knew that they were suffering, and I knew they had questions, and I just wanted to reach out to them. And I never got the opportunity to talk to them. Which is something that I regret, to this day.” Today, Dr. Farley is an advocate of CANDOR, and director of Provider Wellbeing for Christiana Care Health System (6).

Ms. Hemmelgram is also glad to know that healthcare systems are beginning to encourage their medical professionals to accept responsibility for their actions, and to communicate effectively so that mistakes – tragic though they may be – can at least serve as learning experiences. She says that, “The only way for an organization to learn is to show the failures and say, ‘We are fallible, but we’re gonna learn about this; we’re gonna tell you about it, so that all of us together can make the system better” (5).

Sources

  1. Hospitals Can Break Through the ‘Wall of Silence’ with New Toolkit
  2. The Michigan Model: Medical Malpractice and Patient Safety at UMHS
  3. Communication and Optimal Resolution (CANDOR) Toolkit
  4. AHRQ Toolkit Helps Health Care Organizations and Providers Communicate With Patients and Families When Harm Occurs
  5. Introduction to Communication and Optimal Resolution (CANDOR)
  6. Heather Farley appointed director of Provider Wellbeing
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