Christiana Care implements CANDOR

As a recognized national leader in quality and safety, Christiana Care has implemented CANDOR: Communication and Optimal Resolution. CANDOR enables Christiana Care to advance its culture of patient safety by further supporting patients through open communication and optimal resolution when an analysis and event review confirms unexpected patient harm.

Christiana Care was one of only three health systems in the nation — along with Dignity Health and MedStar Health — to partner with the Agency for Healthcare Research and Quality (AHRQ) and the Health Research & Educational Trust of the American Hospital Association in a demonstration project to develop educational resources and tools as part of CANDOR. The demonstration project officially ended in September.

“We believe dealing with medical error transparently and forthrightly is the right thing to do,” said Kathleen McNicholas, M.D., JD, medical director of Performance Improvement, who is co-leader of the project along with Stephen Pearlman, M.D., MSHQS, Quality & Safety Officer, Women & Children’s Service Line. “Learning from error and making improvements are essential to the process. Caring for the caregiver — as well as the family and patient — in these difficult circumstances is vitally important and should never be forgotten.”

“The CANDOR team achieved numerous milestones to prepare for implementation,” said Dr. Pearlman, “among them participation in a change-readiness assessment and gap analysis; creation of a CANDOR event response checklist; education of clinical departments to build awareness and general knowledge of CANDOR principles; and establishment of a Care for the Caregiver Program to support staff impacted by an adverse event contributing to harm to our patients.”

CANDOR is consistent with our promise of The Christiana Care Way to be respectful, expert, caring partners with our patients in their treatment, especially when they are harmed. It supports our culture of responsibility, promotes our learning and reporting culture and enhances our commitment to patient- and family-centered care.

To date, more than 150 participants and key stakeholders at Christiana Care have received training in the four main components of CANDOR:

• Communication: focusing on the importance of disclosure, patient and family communication, and teaching others about disclosure.
• Event reporting and analysis: detailing the CANDOR method for harm event reporting, review and analysis.
• Care for the caregiver: focusing on the ways to identify and support second victims — the caregivers impacted by serious adverse events.
• Resolution and leading the change: describing how to establish a robust resolution process, integrating all knowledge gained through the event review and analysis.

A CANDOR response team will help guide and facilitate managing an event that has contributed to death or permanent harm. This includes coordinating communication with the patient, family and senior leadership, and activating the Care for the Caregiver program.