October 18, 2016

Candor is crucial to success within any organization. Imagine the impact if an entire industry were to focus on candor. Hospitals across the US are doing just that – their efforts are replacing practices of secrecy, denial, and defense attorneys with transparency, apology, and settlement.

Initially, this practice of candor in the event of a mistake or negligence was a hospital-by-hospital program, with each organization choosing its specific approach. But recently, following the great success of improvement and prevention in some of those innovative hospitals, the government has thrown its weight behind it, outlining specific guidelines for hospitals to adopt a more open and honest way of dealing with medical mistakes. The program, managed by the Agency for Healthcare Research and Quality (AHRQ), is called Communication and Optimal Resolution, or (get this!) CANDOR for short.

CANDOR is a process that “health care institutions and practitioners can use to respond in a timely, thorough, and just way when unexpected events cause patient harm” (www.AHRQ.gov). AHRQ offers a CANDOR toolkit, which was formed using expert input and takeaways from its own $23 million Patient Safety and Medical Liability grant initiative. The toolkit includes PowerPoint presentations, notes, checklists, resources, and video instructions to guide organizations through the CANDOR process – it’s candor about CANDOR.


As I describe it, candor is honest, direct and respectful communication that honors the people involved. The AHRQ defines their CANDOR in similar ways. When a case involving patient harm is identified, CANDOR requires*:

  • trained hospital staff communicate with victims or their families about what happened;
  • the hospital staff to stay in touch with patients and relatives as the event is investigated and interview them about what happened (in typical malpractice suits, investigations may be kept secret and patients/families may be excluded from the process);
  • a pause in the billing process;
  • a discussion about how to prevent future incidents;
  • and allows the hospital and the patient to negotiate financial compensation if the harm resulted from a breach in the standard of care.

(*As summarized from the AHRQ CANDOR Event Checklist.)

Historically, when mistakes happened, secrecy may have been the top priority. Now, with CANDOR, a move to more openness offers patients and families what they most often want in the event of a mistake – an acknowledgement that something went wrong.