On June 2, 2017, the 2017 U.S.-Japan Forum was held at Bechtel Conference Center at Stanford University.  The forum discussed three main topics: growth strategy; populism, globalization, and social equality; and technology innovation.

A summary report, full list of panelists, topics addressed and conference agenda can be viewed here.

Sometimes a straightforward explanation and an apology for what went wrong in the hospital goes a long way toward preventing medical malpractice litigation and improving patient safety.

That’s what Michelle Mello, JD, PhD, and her colleagues found in a study published Oct. 2 in Health Affairs.

Mello, a professor of health research and policy and of law at Stanford University, is the lead author of the study. The senior author is Kenneth Sands, former senior vice president at Beth Israel Deaconess Medical Center.

Medical injuries are a leading cause of death in the United States. The lawsuits they spawn are also a major concern for physicians and health-care facilities. So hospital risk managers and liability insurers are experimenting with new approaches to resolving these disputes that channel them away from litigation.

The focus is on meeting patients’ needs without requiring them to sue. Hospitals disclose accidents to patients, investigate and explain why they occurred, apologize and, in cases in which the harm was due to a medical error, offer compensation and reassurance that steps will be taken to keep it from happening again.

Positive results

The study reports on the outcome of a so-called communication-and-resolution program at two large Massachusetts hospital systems. Mello and her co-authors found that the program not only yielded positive results in terms of liability costs but also led to significant patient safety improvements.

“In these programs, hospitals scrutinize every serious harm event to answer the question, ‘What can we learn?’” Mello said. “Traditionally, a risk manager’s focus has been on the patients who complain about the care or threaten to sue. But every patient deserves to know that what happened to them is being taken seriously.”

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Despite concerns that telling patients about errors and proactively offering compensation could cause liability costs to skyrocket, of the 989 adverse events reviewed for the study from 2013 to 2015, only 5 percent led to malpractice claims or lawsuits. And when the program did lead to compensation, the median payment was $75,000. By comparison, the median payment nationwide in 2015 when plaintiffs prevailed in malpractice lawsuits was about $225,000, Mello noted.

“Our findings suggest that communication-and-resolution programs will not lead to higher liability costs when hospitals adhere to their commitment to offer compensation proactively,” the authors wrote.

Pilot program

The authors focused on a program called CARe — Communication, Apology and Resolution — at six Massachusetts hospitals: Beth Israel Deaconess Medical Center and Baystate Medical Center, and two of each center’s community hospitals.

The hospitals demonstrated good adherence to the program protocol, the authors found. Physicians were supportive of the approach but did ask for better communication about the program and what was happening with their patients.

The low percentage of events that led to litigation should reassure hospitals concerned about the risks of being honest with patients, the authors wrote. A likely explanation, according to Mello, is that explaining why adverse events occurred defused patients’ anger. About three-quarters of the time, adverse events were not actually due to error, the study said. Rather, malpractice claims frequently arise when plaintiffs perceive that the health care providers communicated poorly or attempted to cover up negligence, the authors noted.

“Given the rarity with which communication-and-resolution events resulted in settlements, it is reasonable to wonder whether the programs are worth the time they require,” the authors wrote, “but risk managers in our study thought they were. By providing explanations and expressions of sympathy for harms not arising from negligence, communication-and-resolution programs may avert lawsuits springing from misunderstanding.”

Objectives and improved safety

The CARe objectives are to improve transparency surrounding events, improve patient safety, reduce lawsuits and support clinicians in disclosing error or injury.

Medical events were bumped to a CARe evaluation if they met a severity threshold of either causing permanent or temporary harm that led to an extended hospitalization, required an invasive procedure or led to at least three outpatient visits.

Of the 989 total events studied by the authors, 60 of them entered the CARe program because the hospital received notice that the patient intended to sue. Another 929 entered the program when an adverse event was reported that allegedly exceeded the severity threshold, or that met other criteria.

The protocol called for compensation to be proactively offered whenever a violation of the standard of care caused serious harm. Only 9 percent of cases met these criteria. The largest payment made was $2 million. In 181 events, in which compensation criteria weren’t met, hospitals offered to waive medical bills or made other modest gestures, like giving the patients meal vouchers and gift cards. About three-quarters of injuries didn’t qualify for compensation because the standard of care was judged to have been met — a proportion that is consistent with prior studies of medical injuries. About a third of the injuries weren’t caused by the medical care: For example, a patient contracted an infection in the hospital but died from other causes.

“These programs are usually talked about as a way to resolve cases of medical error, but what they do more often is encourage communication with patients about non-error events — as well as systematic evaluation of each event for patient-safety lessons,” Mello said.

The authors also noted that communication-and-resolution programs “can help hospitals foster a culture of transparency by supporting clinicians in making disclosures.”

The safety interventions identified in the CARe investigations included new labeling for high-risk medications, color-coded socks for patients at risk for falls, radio frequency identification tags for surgical sponges, improved interpreter services, improvements for managing the selection of implantables after surgery, and a multidisciplinary checklist for breech deliveries.

Other authors of the study are affiliated with Harvard, Tufts, Baystate Medical Center, and Beth Israel Deaconess Medical Center.

William F. Miller, a former provost at Stanford University, a founding member of the university's Computer Science Department, and former CEO of SRI, died at the age of 91 on Wednesday, September 27.

Miller held an array of other leadership, industry, and academic roles, but at Shorenstein Asia-Pacific Research Center (APARC), Bill was better known as one of the leaders of the Stanford Program on Regions of Innovation and Entrepreneurship (SPRIE), along with Henry S. Rowen and Marguerite Gong Hancock. SPRIE was established at Shorenstein APARC in 2001 after the publication of The Silicon Valley Edge by Stanford University Press, co-edited by Miller, Rowen, Hancock, and Chong-Moon Lee; the book, the program's research, and Miller and Rowen's vast experience were responsible for a steady stream of visitors to Encina Hall, all looking to understand the Valley's success and replicate it abroad.

Two more books were published by SPRIE, focusing on the rise of innovation in Asia: Making IT: The Rise of Asia in High Tech (2006), and Greater China's Quest for Innovation (2008). In 2011, the program moved to the Graduate School of Business.

Full details on Bill Miller's life, as a leader, an entrepreneur, a tireless advisor and advocate, and as a generous human being, can be found here.

Colin Kahl, a top national security expert and veteran White House advisor, has been named to a new senior fellowship at Stanford.

Starting in January 2018, Kahl will be the inaugural Steven C. Házy Senior Fellow, an endowed faculty chair at Stanford's Freeman Spogli Institute for International Studies (FSI). He will be affiliated with the Center for International Security and Cooperation (CISAC). 

Kahl most recently was an associate professor in the Security Studies Program at Georgetown University’s Edmund A. Walsh School of Foreign Service. From 2014 to 2017, he was deputy assistant to the U.S. president and national security advisor to the vice president. In that position, he served as a senior advisor to President Obama and Vice President Biden on all matters related to U.S. foreign policy and national security affairs, and represented the Office of the Vice President as a standing member of the National Security Council Deputies’ Committee. 

Michael McFaul, director of FSI, said, “Professor Colin Kahl is a terrific hire for FSI and Stanford University as a whole. Very few scholars in the United States have both deep scholarly interests and credentials as well as experience and expertise in policymaking. Colin is that rare professor who truly bridges the gap between theory and policy. We are very lucky to have him at Stanford. "

Amy Zegart, co-director at CISAC, said, “Colin Kahl is a tremendous addition to CISAC in every way – a distinguished scholar and educator who has served in senior policy positions at one of the most challenging junctures in U.S. foreign policy. His wide-ranging work spans nuclear risk reduction, U.S. grand strategy, and Middle Eastern politics, and promises to enhance and enrich nearly everything we do at CISAC.”

Kahl said his Stanford plans include conducting research on a range of contemporary international security challenges, including writing a book examining American grand strategy in the Middle East after 9/11. He is also doing research on the implications of emerging technologies for strategic stability and nuclear rivalry. 

For Kahl, joining Stanford is both an intellectual opportunity and a homecoming of sorts.

“Stanford is one of the top universities in world,” Kahl wrote in an email, “with a diverse faculty in the social sciences and natural sciences working at the cutting edge of international affairs and national security. I can think of no better intellectual community to be part of. I also grew up in the Bay Area, so this is a great opportunity to come home.”

National, global security

Many of the issues dominating national security conversations over the past few decades continue to matter today, Kahl said.

“These include nuclear proliferation, threats from international terrorist organizations and other transnational actors, and the competition between the United States and rising global and regional powers,” he said.

Kahl noted that in a “globalized, hyper-connected world,” other critical issues are becoming increasingly important. This includes climate change and environmental sustainability, and the social, economic, and security implications of the digital revolution. It is time to for a scholarly examination of cyber, big data, robotics, A.I., autonomous systems, 3-D printing, and synthetic biology, for example.

“No university in the world is better positioned to help policy makers understand these challenges and craft creative solutions than Stanford,” he added.

From February 2009 to December 2011, Kahl was the deputy assistant secretary of defense for the Middle East at the Pentagon. In this capacity, he served as the senior policy advisor to the U.S. defense secretary for Egypt, Iran, Iraq, Israel, the Palestinian territories, Saudi Arabia, Syria, Yemen, and six other countries in the Levant and Persian Gulf region.

In June 2011, Kahl was awarded the Secretary of Defense Medal for Outstanding Public Service by Defense Secretary Robert Gates. In 2007-2009 and 2012-2014, he was a senior fellow at the Center for a New American Security, a nonpartisan Washington, DC-based think tank.

Publications, research

Kahl wrote the 2006 book, States, Scarcity, and Civil Strife in the Developing World, and has published articles in Foreign Affairs, Foreign Policy, International Security, the Los Angeles Times, Middle East Policy, the New Republic, the New York Times, Politico, and the Washington Post, for example.

He has analyzed the causes and consequences of violent civil and ethnic conflict in developing countries, as well as U.S. intervention practices in those conflicts, with a particular focus on the Middle East.

From 2000 to 2007, Kahl was an assistant professor of political science at the University of Minnesota. In 2005-2006, he served as a Council on Foreign Relations International Affairs Fellow in the Office of the Secretary of Defense, where he worked on issues related to counterinsurgency, counterterrorism, and responses to failed states.

Kahl received his bachelor’s degree in political science from the University of Michigan in 1993, and his doctorate in political science from Columbia University in 2000.

Donor background

The gift for the position was made by Christine and Steven F. Hazy in honor of their son, Steven C. Hazy, who was a CISAC honors student and is now a vice president at Aviation Capital Group, one of the largest commercial aircraft leasing firms in the world. A leader in the aviation industry, Steven F. is the founder of two Los Angeles-based air leasing companies.  In addition to many civic leadership roles in Los Angeles and Washington DC, Christine is a current Stanford trustee and former co-chair of The Stanford Challenge. 

It was CISAC core faculty member Scott D. Sagan's engaging and productive mentorship of their son that inspired the family to establish the new senior fellowship. Steven received his bachelor’s degree from Stanford in International Relations in 2004 and his MBA from the Stanford Graduate School of Business in 2011. Steven serves on the FSI Council.

MEDIA CONTACTS:

Clifton B. Parker, Center for International Security and Cooperation: (650) 725-6488, cbparker@stanford.edu

NBC Bay Area spoke with Shorenstein APARC director Gi-Wook Shin following a press conference held by DPRK foreign minister Ri Yong-Ho on September 25, in which Ri asserted that recent comments by President Donald Trump amounted to a "declaration of war."

The verbal barrage between North Korea and the United States has sharply escalated, with increased U.S. bomber flights near and around North Korea being met by North Korean threats to shoot down such flights, even those outside its borders.

While Shin still holds that the war of words will not turn into war, he is concerned that the escalation of rhetoric is dangerous.

"The South Korean people are really worried about the possibility of a military conflict," noted Shin. He further advised the president to deescalate personal attacks on Kim Jong-un, pointing out that Kim's "god-like" status in North Korea was effectively forcing the DPRK leader to respond to White House threats.

As the war of words escalates between Donald Trump and North Korean leader Kim Jong-un amid a series of North Korean missile launches and a September 3 nuclear test, Gi-Wook Shin, director of the Shorenstein Asia-Pacific Research Center, expressed concern that what is happening "might be more than an escalation of rhetoric. . . there may be escalation of expectations." Read the news item in the Independent here. In an interview with Deutsche Welle, Shin said "one could argue that the [Trump administration's] contradictory messages fit well with its somewhat paradoxical North Korea policy, 'maximum pressure, maximum engagement.'"

In an appearance on PBS Newshour, Kathleen Stephens, former U.S. ambassador to South Korea and William J. Perry Fellow at Shorenstein APARC's Korea Program, expressed concern that the presidential brinkmanship was undermining diplomatic efforts to deescalate tensions on the Korean Peninsula. Stephens suggested the U.S. President "restrain from twittering" the war of words in a recent interview with Yonhap News.

Yong Suk Lee, deputy director of the Korea Program at the Shorenstein APARC, said "the harsh rhetorics going back and forth between Kim Jong Un and Donald Trump may indeed fuel the probability of military action. And it indeed seems like the hardliners are getting  a stronger voice domestically, not just in the U.S., but also in North Korea. However, the increased tension may actually serve as an opportunity. When the stakes are this high — with the possibility of a nuclear war, and for North Korea, an economy that is just starting to develop — the incentive to strike a deal may be higher." Listen to his interview with KCRW: To the Point here.