When patients are harmed in health care, what happens next matters just as much as the care that came before.
A newly co-edited volume, Responding to Harm with Compassion, Accountability and Transparency, available here, brings together leading voices working to transform how health systems respond when things go wrong. Co-edited by Evan Benjamin, MD, MS Director of Community Innovation at Ariadne Labs and Thomas Gallagher, MD, Executive Director for the Center for Harm Response at the University of Washington, the collection highlights both the progress made and the work still ahead to ensure that patients and families receive honesty, support, and meaningful accountability after harm.
Additional Ariadne contributors to the book include Associate Faculty member Stephanie Calcasola, Vice President of Quality and Safety for Hartford Healthcare and Melissa Parkerton, Executive Director of Ariadne Labs’ Pathway to Accountability, Compassion, and Transparency.
At its core, the premise is simple: when harm occurs, patients deserve the truth. Yet, as the editors note, turning that principle into consistent, reliable practice has proven deeply challenging. Harm events often stem not from a single individual, but from complex system failures. At the same time, fear of litigation, reputational damage, and difficult conversations can prevent open communication, leaving patients and families without the information and support they need and limiting opportunities for learning and improvement.
Over the past two decades, Communication and Resolution Programs (CRPs) have emerged as a promising model to address this gap. These programs emphasize early identification of harm, transparent communication, thorough system-focused analysis, and support for patients, families, and care teams, paired with proactive resolution when appropriate. Evidence shows that these approaches can improve both patient experience and organizational learning, without increasing liability costs.
But implementation remains uneven.
The book outlines key priorities for the field: deepening patient and family involvement, strengthening training and language, using data and metrics to drive reliability, better aligning CRPs with patient safety efforts, and thoughtfully engaging regulators to support widespread adoption.
This work closely reflects the mission of Ariadne Labs’ PACT (Pathway to Accountability, Compassion, and Transparency) initiative, which Dr. Benjamin and Dr. Gallagher have helped lead and grow. PACT partners with health systems to design and implement more effective, patient-centered approaches to responding to harm—ensuring that transparency, compassion, and learning are not exceptions, but standard practice. In 2025, the team convened more than 30 national leaders for Charting a Course to Safer Care, informing a widely shared issue brief. The first three waves of PACT have engaged 40 health systems with over 60 teams, with a fourth wave launching in 2026. The ongoing PACT Leadership and Innovation Network continues to cultivate and spread best practices and strengthen patient safety.
“Providing healthcare is a privilege granted by the public,” the editors write. “To improve trust, we must ensure that when harm occurs, patients and families are met with accountability, compassion, and transparency.”
Through his leadership at Ariadne Labs, Dr. Benjamin has been at the forefront of advancing this vision, helping to move the field from aspiration to action. This new volume serves as both a reflection of how far the field has come and a roadmap for what’s next: a future where every patient harmed by their care receives not silence or defensiveness, but honesty, support, and a commitment to do better.