CRICO Celebrates 40 Years in Patient Safety

In 2009, CRICO convened surgical chiefs to work on communication problems between residents and attending physicians, a chronic and recognized patient safety problem. In this case, however, CRICO had identified evidence of the problem through analyzing claims data. It called on one of its insureds, patient safety expert and surgeon Atul Gawande, MD, to be a liaison to the surgical chiefs of four of Harvard’s teaching hospitals: Mass. General, Brigham and Women’s, Boston Children’s, and Beth Israel Deaconess Medical Center. The four chiefs did not know each other well beforehand and met for the first time at the request of CRICO to discuss collaborative opportunities (ElBardissi et al., 2009).

Luke Sato, MD, chief medical officer for CRICO, says conversation was guarded at first. Eventually, one of the chiefs “broke the ice” by sharing a story based on experience at his hospital. The group continued to meet, reviewed published literature, shared their organizations’ interests, and engaged in frank discussion of the problem and possible solutions. Eventually, they started to develop mutual accountability.

Next, with Gawande’s guidance, a working group developed trigger cards to help residents decide when to contact an attending physician (Arriaga, 2011). The tool was shared with the chiefs, all of whom have now implemented it in their organization.

Sato emphasizes, “None of this would work without trust and the collective input of our whole community.” In addition to fostering trust, CRICO facilitates discussion toward a common goal, another crucial part of the convening process. The form and dissemination of the end products vary. Groups may develop white papers, best practices, guidelines, or a tool such as the trigger cards. In each case, the group decides what is needed and how to disseminate it. Many of the materials generated through convening are publically available on CRICO’s website (

Patient safety organization 

CRICO also convenes professionals through its Academic Medical Center Patient Safety Organization (AMC PSO). The AMC PSO is governed by regulations outlined in the Patient Safety and Quality Improvement Act of 2005. Federal listing and programmatic oversight is conferred under the auspices of the Agency for Healthcare Research and Quality. Member organizations from across the country report safety event data to the PSO for analysis and feedback. Information analyzed by the PSO is used to foster a culture of safety and learning within the PSO community.

When unsafe practices at New England Compounding Center (NECC) resulted in the death of 64 patients across the country (Smith et al., 2013), CRICO’s AMC PSO convened a group of leading pharmacists and subject matter experts to study how to mitigate the risks associated with compounding and improve the safety of this practice. The group reviewed available information and evidence, discussed safe practices, and developed guidelines for providers working with compounders, whether they are in-house or through contracted service with outside vendors. When states issued new regulations in response to the NECC event, AMC PSO members were poised to respond as they had already proactively reviewed this issue and were ready to implement safe practices. The recommendations they developed were published as one of the PSO’s monthly Patient Safety Alerts (CRICO, 2013), which are available to the public on CRICO’s website.

National community and clinical coding taxonomy 

In 1998, CRICO established a division called Strategies to extend its patient safety mission beyond the Harvard medical community in Massachusetts. Strategies incorporates and codes claims data from its national members, which represent captive and commercial MPL insurers from across the country. Heather Riah, CRICO’s chief operating officer, points out that CRICO’s insured generate a limited number of claims each year. In specialty areas or narrow practice groups, such as pediatrics, CRICO’s own data sets are very small and grow slowly. Having access to more data through Strategies expands the opportunity to see trends, drill down more deeply, and benchmark against national performance. Member participation in this larger healthcare community represents 550 additional healthcare entities, including 400+ hospitals and 29 academic medical centers. Over time, CRICO has been able to build its national Comparative Benchmarking System (CBS) into a database exceeding 350,000 claims that represents approximately 30% of U.S. medical malpractice cases.