Affinity Program: I-PASS Patient Safety Institute

In a recent Medical Professional Liability Association webinar, Dr. Christopher Landrigan, Chief of General Pediatrics at Boston Children's Hospital, a Harvard Medical School professor, and co-founder of the I-PASS® Patient Safety Institute, explained how structured handoffs can help healthcare organizations prevent patient harm and reduce malpractice exposure.

A patient handoff may last only a few minutes, but a failed handoff can create liability exposure that persists for years. When responsibility moves between clinicians, a missing contingency plan, misunderstood diagnosis, or an unspoken follow-up can turn a routine handoff into a patient harm event, with consequences that may extend to a malpractice claim years later.

Medical and hospital professional liability insurers shouldn’t treat clinical communication only as a provider training issue. Communications failures can contribute to both claim frequency and severity. By supporting structured handoff practices, insurers have an opportunity to address these risks before patient harm occurs.

The Claim Signal Is Clear
A peer-reviewed study published in the Journal of Patient Safety examined a random sample of 498 closed malpractice claims from CRICO Strategies' Comparative Benchmarking System. Communication failures appeared in 49 percent of the claims. Among claims involving communication failures, 40 percent included a failed handoff, and researchers estimated that a structured handoff tool might have averted 77 percent of those failures.

The financial impact is also notable. Claims involving communication failures were rarely dropped, denied, or dismissed compared to claims without them. Their mean total cost was also higher. The average cost across reviewed claims was approximately $154,000, while handoff-related claims averaged approximately $349,000. Communication failures also disproportionately represented among cases with indemnity payments above $1 million.

Modeling based on the study estimated that a structured communication approach could potentially avert 15 percent of all malpractice claims and 27 percent of malpractice claim costs. Landrigan used the $6 billion spent annually on U.S. malpractice claims to illustrate the potential impact. Applying the modeled reduction to that estimate suggests a possible savings opportunity of more than $1 billion per year. For insurers, the findings raise a practical question: where could structured handoffs reduce preventable harm and claim costs among their policyholders?

Why Handoffs Create Outsized Exposure
Handoffs create points of vulnerability across an organization. They occur between shifts, departments, specialties, facilities, and levels of care. Each boundary creates an opportunity for assumptions to replace explicit communication. The study found that contingency plans, diagnoses, and illness severity were among the information types most often miscommunicated.

These cases can also be difficult to defend. A technical complication may leave room for reasonable disagreement about judgment or standard of care. A critical fact that one clinician knew but never passed along is often more visible and harder to explain. Unlike a complex clinical decision, a communication failure may be easier to identify after the fact. The breakdown can occur in the gap between clinicians, teams, or systems, making it difficult to explain why critical information never reached the person responsible for the patient.

Common Sense Is Not a Control
Most clinicians already know what a good handoff should accomplish. But knowing what a good handoff requires doesn’t guarantee that every clinician will consistently follow that same process.

The individual elements aren’t mysterious. The problem is that they rarely happen systematically. Emergency departments, surgical teams, nursing units, and other clinical groups may each use their own language, tools, and expectations. When the sender and receiver work from different mental models, the sender may omit critical details while the receiver may misunderstand what was shared or assume that missing information isn’t important.

A structured framework creates a common language. The I-PASS methodology organizes the exchange around illness severity, a patient summary, an action list, situation awareness and contingency planning, and synthesis by the receiver. The framework gives clinicians a shared structure for communicating essential information, anticipating what might happen next, and confirming that the receiving clinician understands the plan.

Implementation Is the Intervention
Hospitals do not achieve reliable communication by placing a poster on a wall. Sustainable adoption requires workflow design, training, leadership support, standardized handoff tools integrated into clinical workflows, observation, feedback, local champions, and measurement. At its core, a structured handoff program is an organizational change effort.

Landrigan explained that a typical I-PASS implementation begins with three to six months of planning. Large systems often achieve better results by starting in one or two departments or smaller hospitals rather than attempting an enterprise-wide launch at once. Participating units may begin to see improvement in communication measures and staff-reported harm within months, while a full system rollout can take approximately three years.

This phased approach is especially relevant to MPL and HPL insurers and hospital captives. It creates opportunities to define a baseline, select high-risk handoff points, test adoption, measure results, and refine the model before expanding. For insurers, it also provides a way to assess whether a policyholder has embedded handoff practices into daily operations rather than relying on one-time training that may fade as staff and priorities change.

A Practical Agenda for MPL Insurers
Structured handoff communication gives insurers a way to connect claims intelligence with patient-safety intervention. That work can begin with four questions:

1. Where is the exposure concentrated? Analyze claims and incident data for communication breakdowns by service line, transition type, and severity.
2. Which policyholders are ready to implement? Assess leadership sponsorship, safety culture, implementation capacity, and willingness to measure adoption.
3. How will success be measured? Track process reliability, communication-related harm, claim frequency, claim severity, and operational effects over time.
4. How will the change be sustained? Build handoff expectations into onboarding, workflow, technology, coaching, and governance rather than treating the work as a temporary campaign.

ROI analysis should remain disciplined. Savings models depend on an organization's size, claims experience, local legal environment, implementation costs, adoption, and time horizon. A credible business case should make those assumptions visible and test more than one scenario. The point is not to promise a specific return but to weigh the cost of prevention against the clinical and financial burden of a recurring, measurable source of loss.

Landrigan estimates that a structured handoff program typically pays for itself within two to three years when malpractice savings are considered. He also points to additional potential benefits, including fewer resources spent managing adverse events, improved patient throughput, and less wasted staff time. These operational benefits may further strengthen the business case, but their value will depend on the organization and how outcomes are measured.

Landrigan is candid about the challenge of getting structured handoffs into routine practice. “What would it take to really drive this into practice,” he asked during the webinar, “so that everybody’s using this for preventing adverse events and preventing the costs associated with them?” For MPL insurers, the question is how to help policyholders turn evidence-based handoff practices into consistent clinical routines.

The MPL industry usually encounters communication failure only after harm has occurred and a claim has followed. Structured handoff communication creates an opportunity to act earlier. Insurers can use what they know about claims to help healthcare organizations strengthen the moment when responsibility changes hands. By helping policyholders identify high-risk transitions, implement reliable handoff practices, and measure their impact, insurers can support safer care while addressing a preventable source of liability exposure.

This article was developed from a webinar with Christopher Landrigan, MD, Co-Founder and Executive Council Member, I-PASS Patient Safety Institute; Chief of General Pediatrics, Boston Children's Hospital; and Professor, Harvard University. The webinar is available to view here.