By Susan Carr
CRICO, the medical professional liability (MPL) insurance company for the Harvard medical institutions and affiliates, is celebrating its 40th anniversary this year. In addition to providing members with liability coverage and claims management, CRICO has made reducing the risk of harm and improving patient safety a priority for the benefit of patients and providers of its member institutions and national clients. CRICO has become a leader in patient safety while continuing to serve its members’ needs by fostering a culture of safety, using data to identify risk and develop solutions, valuing professional relationships, and sharing its knowledge.
Early work in patient safety
CRICO’s dedication to learning and clinical improvement dates back to its origins, when external events led Harvard to create a new kind of MPL insurance company. Malpractice premiums throughout the country, including Massachusetts, spiked in the late 1970s. Leaders of hospitals affiliated with Harvard devised a plan to reduce premiums by working together to improve quality, reduce risk, and control cost. With the blessing of Harvard President Derek Bok and Robert Ebert, dean of the Harvard Medical School, the group established one of the first captive liability insurance companies to serve Harvard’s medical institutions; a model that many health systems subsequently followed.
By supporting early research efforts of members of the Harvard medical community, including Drs. Lucian Leape, David Bates, and Atul Gawande, CRICO participated in foundational work during the earliest days of the patient safety movement. With a robust grants program, CRICO continues to invest in clinicians’ research efforts with funding and data access. And in all these efforts, CRICO looks beyond its members to share what it learns about problems and solutions with a growing national community.
For a captive insurer, CRICO’s size is unusual. Most captives serve one health system, but CRICO serves 11 distinct organizations, covering all of their nearly 13,000 physicians, and 100,000+ affiliated clinicians and employees. Although the hospitals and practices CRICO serves could be considered “family” within the Harvard community, in reality, they are highly competitive with each other in the Boston market. At the same time, gathering clinical experience, data, and knowledge across all levels of its member organizations and encouraging them to work together to improve patient safety, offers incomparable opportunities for learning. CRICO has been able to use its size, structure, and culture to convince members to put competition aside in the interest of clinical improvement. When leveraged properly, the community’s whole is far greater than the sum of its parts.
Convening for safety
CRICO’s tradition of bringing members together to address specific issues—“convening”—captures the collective knowledge of professionals who are usually competitors to solving problems to benefit the common good. CRICO convenes influential representatives of the community to work on issues identified through claims analysis as most vulnerable to risk. Through face-to-face meetings and facilitated discussion, trust develops over time. CRICO is able to leverage its unique position, and use positive incentives and data to drive change.