Patient Satisfaction News

AHRQ Patient-Centered Toolkit to Boost Provider Communication

AHRQ's toolkit, CANDOR, will support provider communication and promote provider honesty with patients when there are issues in their care.

By Sara Heath

- The Agency for Healthcare Research and Quality has created a new patient-centered toolkit helping to support patient-provider communication following adverse hospital events.


The federal agency this week announced the release of the Communication and Optimal Resolution (CANDOR) toolkit that not only helps providers better mitigate adverse events, but helps them communicate the issue with their patient in an empathetic manner, ideally boosting patient satisfaction despite the adverse event.

AHRQ indends for providers to use CANDOR when patients experience some sort of harm, such as an injury or hospital acquired condition, as a direct result of the care they received.

These adverse events happen more frequently than one may expect.

According to an AHRQ press release, about 10 percent of patients experience harm while receiving care in the hospital. This causes issues on both the patient and provider side, because it is often difficult for providers to adequately address these issues in an effective manner.

The toolkit’s overarching theme, according to its introductory documents found on the AHRQ website, is supporting better communication between patients and providers, even during difficult care encounters.

CANDOR also provides guidance on the following specific touchpoints:

  • Forming an active, multidisciplinary project team that includes clinicians, support staff, and patient and family advisors.
  • Conducting training sessions on the CANDOR process for all project team members.
  • Conducting ongoing communications and education with staff, patients, and families about the organization's commitment to the CANDOR process.
  • Engaging staff, patients, and families in the planning, implementation, and evaluation of the CANDOR process.

AHRQ leaders hope the new toolkit will help reduce the twofold harms patients who experience adverse effects often experience.

"Medical harm can impact patients twice — first by the harm itself, and then by the wall of silence that can follow," said AHRQ Director Andy Bindman, MD. "This toolkit helps foster honest and transparent communication in an effort to rebuild trust and support safer care for patients."

By putting the patient first, and then coordinating care and conversations from there, the CANDOR toolkit can help drive the flow of empathetic patient-provider communication to ensure that a hospital-related issue does not go unresolved.

"Every day in American hospitals, countless doctors, nurses and other caregivers perform miracles for patients. And while one incident is one too many, sometimes errors occur," said Richard J. Pollack, president and CEO of the American Hospital Association, which partnered with AHRQ to develop CANDOR.

"This toolkit helps everyone involved — patients, families, clinicians, and administrators — discuss what happened, agree on a resolution and make care safer in the long run."

In the end, this tool boils down to one important aspect of provider communication: honesty. In a blog post, Bindman addressed the issue of honesty in provider communication, saying that promoting honesty amongst providers is at the core of CANDOR’s mission.

“Here's why CANDOR matters: when an adverse event occurs, hospitals and providers often clam up,” he wrote. “What had been a medical process suddenly becomes a legal one. This serves nobody—not the patient, not the clinician, and not the hospital.”

As much as clinicians try to avoid them, Bindman said, mistakes do indeed happen, and it’s important that the healthcare industry determines an effective way to address those mistakes to help foster a culture of transparency between patients and providers.

“But mistakes do happen—much more frequently than we would like to admit. It has been estimated that medical errors are the third-leading cause of death in the United States and that the majority of clinicians have experience with a medical error that resulted in harm to a patient,” he explained.

“The CANDOR process encourages us to proactively disclose harm to patients and families as soon as it happens. It is also important for us to engage with colleagues to reflect on the mistake and explore the root causes of how it happened. This helps us to learn from the situation and take steps to minimize the chances of a similar mistake happening again to another patient.”

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