Recognize and stabilize
Attend to urgent care needs, report the concern through the proper channel and preserve relevant information.
Guidance for care teams
Responding well after unexpected medical harm
Practical orientation for clinicians and administrators working to communicate openly, review events fairly and turn findings into safer care.
A structured response keeps immediate care, respectful communication and organizational learning connected.
Choose your route
Information organized for provider roles
Clinical and administrative teams have related but distinct responsibilities. Start with the route that best fits your work, then use the FAQs for practical orientation.
Communication and resolution
A coordinated alternative to silence and delay
Unexpected outcomes can affect patients, families and care teams, whether they arise from preventable harm, recognized complications or the inherent risks of care. An effective institutional response begins with current clinical needs and continues through timely communication, careful review and follow-up.
The communication, apology and resolution approach—often shortened to CARe—organizes these responsibilities into a consistent process. It supports factual disclosure, appropriate acknowledgment, and fair consideration of resolution when review determines that care did not meet the applicable standard.
- Identify and report concerns promptly
- Address immediate patient care and support needs
- Review the event using a fair, consistent process
- Explain findings in clear, compassionate language
- Apply lessons to reduce the chance of recurrence
The response should distinguish the facts known now from findings that still require review.
How the process works
Four connected responsibilities
No single sequence fits every event. These stages provide a practical framework that organizations can adapt to established clinical, safety and legal procedures.
Communicate
Acknowledge what happened, explain confirmed facts and set realistic expectations for updates.
Review fairly
Examine clinical decisions, system conditions and whether the outcome reflected preventable harm or a recognized risk.
Resolve and learn
Share findings, consider an appropriate response and track safety improvements through completion.
What is included
A provider response needs both people and process
Support for patients and families
Provide a clear point of contact, address ongoing care needs and communicate in understandable language. Questions should be documented and revisited as information becomes available.
Support for clinicians and staff
Care team members may need confidential peer or professional support as well as clear guidance about reporting, review participation and communication responsibilities.
Consistent event review
Review should consider the clinical record, team perspectives and system conditions without reaching conclusions before the relevant information is assessed.
Documented improvement
Lessons should become assigned actions with ownership, follow-up and a method for confirming that changes have been implemented.
Educational scope: Macrm Injury offers general information, not case-specific medical or legal advice. Providers should follow applicable law, professional duties and their organization’s approved policies.
Helpful resources
Documents from the provider archive
These materials offer additional context. Organizations should verify that legal and regulatory documents remain applicable before relying on them.
Program reports
Archived reporting explores communication-and-resolution programs and their approach to claims, resolution and patient safety.
Open the reportsReporting requirements
Review archived federal liability reporting requirements and related state provisions.
Download the textClinical commentary
An archived opinion article considers this model from a medical professional perspective.
Read the commentaryDisclosure presentation
A presentation reviews developments and future directions in disclosure following unexpected outcomes.
Download the presentationProvider FAQs
Common questions from care teams
What should happen first after an unexpected outcome?
Address immediate clinical needs, notify the appropriate internal team and preserve relevant information. Early communication should acknowledge the concern without speculating about causes before review.
Should clinicians wait for a completed review before speaking?
Patients and families should not be left without communication. Share confirmed facts, express appropriate concern and explain what will happen next. Findings that remain under review should be described that way.
What is the difference between disclosure and apology?
Disclosure communicates what is known about the event and subsequent review. An apology or acknowledgment addresses the human impact. The wording and timing should follow organizational policy and applicable professional guidance.
How are recognized complications distinguished from preventable harm?
A structured review considers the patient’s condition, known risks, clinical decisions, accepted standards and system factors. Conclusions should follow evidence rather than assumptions based only on the outcome.
How should a clinician prepare for a disclosure conversation?
Coordinate with the designated response team, review confirmed information, identify who will attend and plan how ongoing care, questions and follow-up will be addressed.
What support may care team members need?
Organizations can provide confidential peer support, access to professional services, clear process updates and practical guidance for participating in review and communication.
Does this approach remove a patient’s legal options?
No. A communication-and-resolution process is intended to support openness and fair response; it does not replace rights or professional advice available under applicable law.
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