Safer Patients: Using CANDOR to Improve Health Equity

March 15, 2022 Fiona Sykes

“Everyone agrees we want to be honest with families when harm happens, but how do you do that,”
asks Ryan Solomon, VP and General Counsel for Arkansas Children's, an organization striving to provide safer care to their pediatric patient population.  

There’s no clear answer, but we do know prioritizing transparency after an adverse event is more of an art than it is a science. When harm happens, clinicians have historically been trained to deny and defend. CANDOR helps health systems to support their clinicians compassionately and holistically after an adverse event and respond with increased transparency and honesty to patients and their families. 

CANDOR trains health systems to starts with a conversation that happens immediately after the harm event. This conversation is purely focused on disclosure of the adverse event, telling families and the patient what is known, what is unknown, and what the organization is doing to find out what is unknown. Solomon notes that this step is paramount to building trust with patients and families and is a surprisingly simple way to begin the process because so much is still unknown. However, simple does not mean easy. These are difficult conversations that take skilled and practiced communication, supported by CANDOR trainings and mock conversations to prepare. 

This first conversation stands as a promise that the conversation between the health system and the patient has begun and will continue.  

Doing the right thing takes courage 
Situations where a harm event has occurred, but a family is not positioned to be a strong advocate – for example, a family on Medicaid who is unlikely to pursue litigation – are some of the situations where using CANDOR takes the most courage.  

To strive for more equitable access to quality healthcare, Arkansas Children’s, whose patient population is overwhelmingly insured by Medicaid, is practicing transparency and authenticity with every family regardless of background or payer. Even when the health system has not yet determined whether the adverse event was in fact preventable, Arkansas Children’s has decided for themselves that beginning the conversation with the patient and family is always the most ethical decision. 

At the core of it, when families pursue litigation, they aren’t really seeking money – they’re looking for the truth – and that’s why they’re suing. Arkansas Children’s reported their patients and families list money as a third or even fourth incentive. 

Knowledge is power 
Striving to improve health equity is honorable, but hard to do without specific and consistent data to identify patterns and make improvement decisions. Arkansas Children’s is in the process of breaking down their event analysis by race, ethnicity, language and socioeconomic status. More equitable care begins with clean data. Collecting that data requires staff who feel comfortable asking patients to share their identities in a way that builds trust with the patient and families, a skill that can be learned through CANDOR. Correctly identifying people is the only way to effectively quantify adverse event data and connect it to health outcomes of various vulnerable populations. Having access to this data empowers organizations to provide equitable access to quality care to achieve a better, safer patient experience. 

This cultural shift doesn’t happen overnight – but it is possible 
This work takes time. Solomon’s advice to others who are considering embarking on this journey is to “expect to have missteps, expect to have disagreements, expect to have the fortitude to do what’s right for your patients and your families.”  

Not all social determinants of health can be governed by a health system – but where we do have an opportunity to make an impact, it is our collective responsibility as an industry to provide a more equitable and safer patient experience, a safer workforce environment and an overall safer organization.

Interested in hearing more from Arkansas Children’s, including how they encouraged buy-in from their providers and clinicians? Watch the full video from our 2021 Boston Connections event

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