As part of its Mission, the Silverman Institute serves as the coordinating center within BIDMC for innovative research targeted toward expanding and enhancing the application of quality improvement tools and techniques in health care. On-going research efforts include:

Communication, Apology, and Resolution Program (CARe)

BIDMC is one of six pilot sites participating in Communication, Apology, and Resolution (CARe). This program was funded by several medical and liability insurers, and physician groups in the state. The Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI) was created to support the program and promote its use.

CARe has five goals:

  1. Improve communication and transparency about adverse outcomes;
  2. Support patients and families to help achieve a fair, timely and healing resolution to medical harm;
  3. Support clinicians in disclosing unexpected outcomes to patients;
  4. Improve patient safety by learning from errors and near misses and preventing future harm; and
  5. Provide an alternative to lawsuits and their unnecessary costs by meeting the financial needs of injured patients and their families quickly in the aftermath of an injury, without resorting to litigation.

If you are a patient and you have a concern about the care you received and think you might benefit from your care being reviewed through the CARe program, please contact BIDMC’s Patient Relations department at 617-975-9750 or

To follow BIDMC's and the other pilot sites' work, please visit the MACRMI’s website at The website includes free resources for patients and providers, a discussion forum, and more detailed information on the program and its history.

BUILDING THE KNOWLEDGE AND SKILLS OF Physician Leaders in Hospital Settings

Sponsored by the Physicians Foundation and led by experts in health care systems improvement at the Silverman Institute for Health Care Quality and Safety and the BIDMC Organizational Development (OD) team, this project aims to increase the pipeline of physicians prepared to lead change in rapidly-evolving health systems settings. The model focuses on developing the leadership skills of a cadre of competitively-selected physicians and would be easily replicated by other institutions. Key elements include leadership style assessment, didactic and experiential learning modules led by senior hospital executives (CEO, CFO, COO) and others, ongoing coaching, and mentorship by senior physicians. Because the model is based at the Medical Center and not treated as an off-site training program divorced from the clinician's assumption of a leadership role, it is an innovative way to integrate leadership development within the institution.

"Time-Varying Risks and Outcome Measurement: The Pernicious, Pervasive Patient-Day."

Funded by the Robert Wood Johnson Foundation, this research seeks to identify quality metrics which do not accurate reflect how risk varies as a function of time and across different phases of clinical care (such as falls per 1,000 patient-days) and how use of these metrics can lead to misleading or biased estimates of the effect of interventions. This research seeks to develop and validate a strategy for overcoming these limitations, leading to more reliable CQI measurement techniques for phenomena with time-varying exposure risk. Knowledge gained in this work will thus become part of the scientific literature and available to all.

"Program to Accurately Assess and Reduce Patient Harm"

Funded by the RX Foundation, this large 3-year grant award will advance our "Program to Accurately Assess and Reduce Patient Harm" and enables BIDMC to:

  • broaden internal efforts to report all harm, evaluate contributory factors and assess opportunities for prevention;
  • collaborate with IHI to conduct an evaluation of our systems for capturing harm;
  • enhance our centralized repository for capturing of harm events, analysis and reporting; and
  • create a robust mechanism for disseminating information about harm events and structures this information in a way that findings can be publicized to the clinical and academic communities.

"Making Ambulatory Procedural Care Safer: STAMP-Based Risk Assessment and Redesign - Model Validation"

Funded by the Agency for Healthcare Research and Quality, this grant funds BIDMC's initiative to design, implement and evaluate a series of interventions aimed at reducing the system pressures that create unsafe operating conditions within the ambulatory procedural domain. This grant supports development of a toolkit for use by other organizations, based upon the ideas tested and implemented at BIDMC.