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It's one of the most difficult conversations a physician can have with patients and family members: explaining that a treatment or procedure has resulted in unexpected outcomes that can, in some cases, involve patient harm.

Yale New Haven Health System has adopted the position that in these situations, honesty and openness are the best policies. Two years ago, the health system implemented the CLEAR (Communication Leads to EArly Resolution) Program at all YNHHS hospitals.

"Our medical staffs continuously deliver high-quality care in a complex environment, but unexpected outcomes sometimes occur," said Alan Kliger, MD, who oversees the program. "Research shows that patients appreciate honest, transparent communication from their physician that clearly explains what happened and what might have been handled differently. Patients and family members also appreciate a sincere, empathetic apology."

Physicians have had these types of disclosure conversations with patients and families in the past, but the CLEAR Program provides a standardized approach, tools, training and support. YNHHS has trained 80 physicians system-wide as CLEAR peer coaches.

Under the CLEAR Program, when errors in care or unanticipated outcomes occur, the clinician first reports the information to the Risk Management department. The attending physician most directly responsible for that patient's care must then disclose events to the patient and, when appropriate, family members or designated representatives. If the attending requests assistance, the risk manager can help identify a CLEAR coach to work with the attending to plan disclosure conversations and, if requested, participate in those conversations with patients.

A list of CLEAR coaches is available on the YNHHS intranet, Legal and Risk Services department, under FAQs. For more information, contact Danielle Goncalves, CLEAR Program coordinator, 203-688-1245. During off hours, follow the procedures for contacting the Risk Management department.