Creating Standards for Communication and Resolution When Things Go Wrong

Thomas H. Gallagher, M.D.



“Providers needed a better understanding of how to communicate with patients when something goes wrong and ensure appropriate resolution. With funding from AHRQ, I have been able to help develop the evidence base for effective disclosures to patients when things don’t go as planned—work that has led to the development of Communication and Resolution Programs such as CANDOR.”


Research shows that about 1 in 10 patients is harmed by medical care, despite the best efforts of the doctors, nurses, and other health care providers. Thomas H. Gallagher, M.D., a general internist and professor in the Department of Medicine at the University of Washington in Seattle, has devoted his career to addressing the best way to communicate with patients when things go wrong and learn from those incidents to improve patient safety.

It’s a problem he first encountered during medical training when he couldn’t find guidelines for physicians on how to talk with patients when an error or problem occurred in their care.  His research—much of it funded by AHRQ—contributed to the knowledge that effective disclosure can improve the physician-patient relationship, potentially decrease medical malpractice costs, and ultimately promote patient safety, if learning results from these situations.

In 2005, Dr. Gallagher published results from a 3-year research grant to develop, evaluate, and disseminate disclosure standards and training to help clinicians inform patients about medical errors. As the first of his AHRQ-funded research projects, this study set the stage for his future work that focused on making care safer by addressing medical errors through effective communication.

A cornerstone of Dr. Gallagher’s approach is to use medical errors as a learning opportunity for all involved parties and for the organizations at large. A non-punitive response to errors builds trust and collaboration and “helps to create environments where we can overcome our natural inclinations to not disclose medical errors to patients or our colleagues and instead learn from errors to minimize the likelihood of repeating them,” he said.

To date, Dr. Gallagher has been the principal researcher for six AHRQ research grants and has authored or co-authored dozens of journal articles resulting from AHRQ-funded research. His work has helped to develop effective training methods for clinicians to learn how to be transparent about medical errors, determine if communication training improves health care outcomes, and find out how patients prefer to be told about medical errors. He has also conducted research to distill these findings into general standards that could be applied in any health care setting.

Dr. Gallagher is one of the expert faculty members who helped to develop AHRQ’s Communication and Optimal Resolution (CANDOR) toolkit, which offers methods and tools for hospital leaders and physicians to use to respond immediately when patients are harmed by the medical care they receive.

To help hospitals adopt these standards and methods, Dr. Gallagher created the Collaborative for Accountability and Improvement, a non-profit organization that helps medical centers implement the CANDOR toolkit for themselves. Currently, Dr. Gallagher has AHRQ funding through 2019 to develop a certification program for clinicians that focuses on communicating effectively with patients when something unexpected happens during care.

These efforts, along with his research and expertise in transparent communication around medical errors, earned him the 2018 John M. Eisenberg Patient Safety and Quality Individual Achievement Award from The Joint Commission and the National Quality Forum.

Principal Investigator: Thomas H. Gallagher, M.D., General Internist
Institution: University of Washington
Grantee Since: 2001
Type of Grant: Various

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Page last reviewed August 2018
Page originally created August 2018
Internet Citation: Creating Standards for Communication and Resolution When Things Go Wrong. Content last reviewed August 2018. Agency for Healthcare Research and Quality, Rockville, MD.
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