About

Thomas H. Gallagher, MD, is a general internist and a Research Professor at the Johns Hopkins Berman Institute of Bioethics. His research addresses the interfaces between healthcare quality, communication, and transparency. Dr. Gallagher has published over 160 articles and book chapters in leading journals. He is the Executive Director of the Collaborative for Accountability and Improvement, an organization dedicated to implementing Communication and Resolution Programs (CRPs) for responding to harm events in healthcare. He co-founded the Pathway to Accountability, Compassion, and Transparency (PACT), a national CRP learning community involving nearly 50 organizations. In 2017, his work advancing CRPs was recognized with the John M. Eisenberg Patient Safety and Quality Award for Individual Achievement, presented by the National Quality Forum and The Joint Commission. Dr. Gallagher has also served as Principal Investigator on multiple AHRQ and foundation grants, beginning with his K award from AHRQ in 2003. Additionally, he holds faculty appointments at the University of Washington as a Professor in the Department of Medicine and in the Department of Bioethics and Humanities.

Research topics

• Medicine
• Psychology
• Medical education
• Computer Science
• Pathology
• Psychoanalysis
• Business
• Psychiatry
• Law
• Virology
• Psychotherapist

Selected publications

• Programs for responding after patients are harmed by their healthcare: A making healthcare safer IV rapid review

  Journal of Patient Safety and Risk Management · 2026-03-12

  articleOpen access

  Background Patient harm from healthcare is prevalent, serious, and can be long lasting. How healthcare organizations respond has implications for patients, families, healthcare professionals, and organizations. We sought to synthesize the evidence on the effectiveness of communication and resolution programs (CRPs). Methods Harm response programs that incorporated communication with patients and families, event review, quality improvement, and in a qualifying subset of events, an apology and an offer of compensation were included. We searched PubMed and the Cochrane Library for systematic reviews and primary studies published from 1 January 2010 to November 2025, supplemented by a review of gray literature. Results We retrieved 2801 citations, of which nine primary studies and no systematic reviews were identified as eligible. The studies focused on medical malpractice experience and financial outcomes. The most robust CRPs reduced the rate of claims, and defense legal fees and expenses (strength of evidence: low). Time to resolution, rate of lawsuits, overall costs to healthcare organizations, and settlement amounts decreased or had no significant change. Evidence was lacking or limited for CRPs’ effects on: other aspects of patient, family, or clinician outcomes or experience; patient safety; quality of care; communication and relationships between patients, families, and organizations; and interprofessional communication. Conclusions CRP implementation is supported by evidence of positive or neutral effects on organizational liability and cost outcomes, but more research is needed to determine the effects on patient, family, and clinician-oriented outcomes.

  PublisherDOI

• A closer look at the role of apology in error disclosure: a simulation study

  Frontiers in Health Services · 2025-06-03

  articleOpen accessSenior authorCorresponding

  Background: The importance of open communication following harmful medical errors is widely accepted including the role of authentic apology. Yet, disclosure conversations remain difficult for clinicians and offering an authentic apology is challenging. Purpose: To better understand how clinicians can improve disclosures and apologies by using simulation to observe the approach clinicians use in the initial disclosure, where and when apologies occur within these conversations, what content apologies are linked with, who apologizes, and how apologies differ by their timing within the overall disclosure conversation. Methods: Forty-nine simulations of physician-nurse teams from the U.S. and Canada were videotaped planning and disclosing either a medical or surgical error to a patient-actress. Data from the disclosure portions were coded and analyzed using Atlas-Ti to describe the communication approach clinicians use when disclosing errors and the occurrence and timing of apologies within those disclosures. Results: Ninety-eight clinicians participated: 38 MD-RN teams from the U.S. and 11 from Canada. Of the 49 total simulated error disclosures, 30 involved medical teams disclosing an insulin overdose; 19 were surgical teams disclosing a lost specimen. The average length of the error disclosure conversations was 9.8 minutes (range = 6.1-14.2 min) and tended to follow a similar roadmap. On average, teams offered 2-3 apologies per disclosure (range = 0-9). These apologies occurred at all points during the disclosures and were offered by both physician and nurse participants. Discussion: Clinicians approached the initial disclosure conversations by addressing nine topics in a relatively consistent order. Apologies occurred throughout the disclosures. With opening comments, clinicians apologized to foreshadow bad news; with closing comments, they linked their remorse to broader professional and organizational goals around patient safety and transparency. Within the disclosure, clinicians sometimes linked the apology to their own emotional experience. More frequently, they linked apologies to the patient's emotional response, which may be more effective to ensure that patients hear that the clinicians' remorse is linked to patient suffering rather than clinician discomfort. To improve these difficult discussions, training materials and guidelines for communicating with patients after harm should reflect the complex role that apologies play.

  PublisherOA PDFDOI

• Error disclosure: what residents say and what patients find effective

  Frontiers in Health Services · 2025-06-20

  articleOpen access

  Background: Medical error disclosure to patients is a critical skill that is often not taught effectively in medical training. The Video-based Communication Assessment (VCA) software enables trainees to receive feedback on their error disclosure communication skills. The VCA method also allows examination of the specific types of error disclosure responses that patients value most. Objective: The primary aim of this study was to describe the language medical residents use to disclose a hypothetical harmful medical error, and to determine the language associated with higher ratings by crowdsourced laypeople. A secondary aim of this study was to examine the alignment between error disclosure content recommended by experts and the communication behaviors that contribute to higher layperson ratings of disclosure. Methods: 102 resident physician responses to a case depicting a delayed diagnosis of breast cancer and their crowdsourced ratings were analyzed using thematic content analysis. We assessed the presence of specific themes in response to three sequential video prompts within a clinical case. Linear regressions were then performed for each prompt's response to examine the extent to which each theme predicted overall communication scores from layperson raters. Results: = 98, 96.1%) residents provided at least one response expressing a component of empathy. However, only 57.8% of residents openly acknowledged that the care was delayed, and 67.8% expressed a plan to prevent future errors. A few residents used rationalization (5.9%) or minimization (4.9%) behaviors; responses with these behaviors were associated with negative beta-coefficients, although this finding did not reach statistical significance. In a linear regression analysis, the strongest positive associations between resident responses and patient ratings were clustered around expressions of accountability (0.48), personal regret (0.47), apology (0.34), and intentions to prevent future mistakes (0.34). Conclusion: Resident physicians vary in which communication elements and themes they include during error disclosure, missing opportunities to meet patient expectations. While infrequent, some residents employed minimization or rationalization in their responses. Utilizing an assessment and feedback system that encourages responders to include themes layperson raters value most and to omit harmful expressions could be an important feature for future software for error disclosure communication training.

  PublisherOA PDFDOI

• Ensuring Safe Practice by Late Career Physicians

  Annals of Internal Medicine · 2025-09-01

  letter
  PublisherDOI

• Supporting the Safe Practice of Physicians as They Age

  2025-01-01

  book-chapter1st authorCorresponding

  Abstract Self-regulation is a pillar of professionalism. Supporting the safe practice of physicians as they age presents a test case of self-regulation that the profession is currently failing. Other safety-conscious industries scrutinize the performance of their practitioners more closely as they age. Yet historically the profession has relied solely on traditional peer review and credentialing processes regardless of physician age. A growing literature links increasing physician age to worse patient outcomes. In response, organizations are increasingly adopting formal late career practitioner (LCP) programs that screen all physicians over a certain age for physical and cognitive well-being. When Yale New Haven Hospital conducted screening cognitive assessments on physicians over 70, 12.7% of the 141 clinicians screened had deficits likely to impair the practice of medicine. Taking a more proactive approach to promoting the safe practice of physicians over the course of their career represents an important new frontier of medical professionalism.

  PublisherDOI

• Leveraging Electronic Health Record Review to Identify Root Causes of Unplanned Intensive Care Unit Admissions

  American Journal of Respiratory and Critical Care Medicine · 2025-05-01

  articleSenior author

  Abstract RATIONALE: Unplanned ICU admissions from acute care are common and often indicate adverse events. These admissions carry a high risk of death and are linked to poor communication and lower family satisfaction with care. There has been considerable focus on predicting these events but less attention to understanding their root causes. Traditional root cause analysis, which involves interviews of staff as well as review of the electronic health record (EHR), is a labor-intensive approach to assessing unplanned ICU admissions, and it is impractical for developing an understanding of these events on a significant scale. Our goal was to develop a process that could provide insight into root causes using only information available in the EHR. METHODS: We conducted a prospective cohort study of patients with unplanned ICU admissions at 3 sites (an academic medical center, a safety-net hospital, and a community hospital in Seattle, WA). We used purposive sampling based on patient demographics (age, sex, race/ethnicity) and system factors (hospital site, provider service) to select admissions for review. We interviewed personnel involved in each unplanned ICU admission and independently reviewed the EHR for each case. The Prevention and Recovery Information System for Monitoring and Analysis model was used to categorize contributory factors, with the following categories: technical, organizational, human, and patient. Factors identified in interviews were compared to those found through EHR review alone, allowing us to pinpoint similarities and differences across each approach. RESULTS: We interviewed 68 clinicians and conducted EHR reviews for 31 unplanned ICU admissions (Table 1). Insights from interviews and EHR reviews helped refine descriptions of contributing factors and led to the development of an additional contributor that was added to the existing classification system: human communication. In both interviews and EHR reviews, human factors (e.g., critical thinking, monitoring) and patient disease were frequently identified as potential contributors to unplanned ICU admissions. Compared to interviews, EHR reviews were less likely to identify organizational factors as potential contributors, particularly those related to organizational culture. Similarities and differences across each approach informed the development of a highly structured protocol for EHR review, designed to address gaps encountered when using the EHR alone. CONCLUSIONS: The EHR can be used to identify potential contributors to unplanned ICU admissions. Given the relatively shorter time required for EHR review compared to a traditional root cause analysis, using the EHR alone for event review may offer a more efficient approach to analysis.

  PublisherDOI

• Incorporating the video communication assessment for error disclosure in residency curricula: a mixed methods study of faculty perceptions

  Frontiers in Health Services · 2025-08-29

  articleOpen access

  Introduction: U.S. resident physicians are required to demonstrate competency in disclosing patient safety events to patients, including harmful errors. The Video-based Communication Assessment (VCA) is a novel tool that provides opportunities to practice and receive feedback on communication skills. VCA practice and feedback are associated with improvements in residents' error disclosure skills, but no research exists regarding faculty members' views on implementing the VCA in patient safety curricula. We sought to evaluate faculty members' views on using the VCA for teaching error disclosure communication in residency, and to identify barriers and facilitators to VCA adoption. Methods: Mixed methods study using a validated survey of Acceptability, Appropriateness, and Feasibility (AAF), and thematic content analysis of structured key informant interviews with faculty. Results: 25 faculty completed both the AAF survey and interview. Overall, the faculty rated the VCA with a mean AAF score of 4.23 (out of 5). Analysis of the interviews identified case quality, relevancy, and fulfillment of a curricular void as attractive aspects of the tool, while feedback delays and content were identified as limitations. A major challenge to implementation included finding curricular time. Faculty anticipated the VCA would be useful for resident remediation and could be used in faculty coaching on error disclosure. Conclusion: The VCA seems to be an acceptable and feasible tool for teaching error disclosure; this finding warrants confirmation and testing in other specialties. Faculty members expected the VCA would be useful for both improving poor performance as well as informing faculty coaching, although these approaches remain untested. To facilitate adoption, faculty recommended protecting curricular time for VCA use and effectively communicating with residents about who will review their personal assessments and how the exercise will support their learning.

  PublisherOA PDFDOI

• Programs for Responding to Harms Experienced by Patients During Clinical Care

  2025-04-02 · 2 citations

  report

  Objectives. This rapid review synthesizes the current literature on the effectiveness of programs used by healthcare organizations to respond after patients experience harm during their care. We focused on communication and resolution programs (CRPs) that included communication with the patient and family, event review, quality improvement, and in a qualifying subset of events, an apology for causing harm and an offer of compensation. Methods. We searched PubMed and the Cochrane Library for systematic reviews and primary studies published from January 1, 2010, to July 2024, supplemented by a targeted review of grey literature. Findings. We retrieved 2,419 citations, of which 8 primary studies and no systematic reviews were eligible for review. The studies focused on medical malpractice experience and financial outcomes, including time to resolution, cost to healthcare organizations, and rate of claims. The effects of CRP implementation on these outcomes were decreases or no significant changes, with no significant increases being reported. Evidence was lacking or limited for CRPs’ effects on other aspects of patient, family, or clinician outcomes or experience; patient safety; quality of care; communication and relationships between patients, families, and organizations; and interprofessional communication. Conclusions. Despite their patient-centered design, studies of CRPs’ effects have focused on organizational liability and cost outcomes rather than patient-oriented outcomes. CRPs appear to have positive or neutral effects on the measured outcomes, with no significant negative effects. Our findings support the implementation of CRPs while highlighting the need for more research about patient, family, and clinician-oriented outcomes.

  PublisherDOI

• Responding to Problems in Dental Practice with Transparency and Accountability

  Journal of the California Dental Association · 2024-03-25 · 1 citations

  articleOpen accessCorresponding

  Background Few situations are as stressful for dentists as when a harmful error has occurred in their care of a patient. Embarrassment, fear of litigation, and uncertainty about what to say and how the patient will react can complicate the response. While most dentists are committed to responding to problems with transparency and accountability, turning these principles into practice can be difficult.Description In this article, we discuss the lessons that dentistry can learn from the field of Medicine about being more transparent with patients about care problems and aligning this transparency with broader efforts to promote a culture of safety where openness and accountability drive learning and improvement. Transparency is recognized as a precondition to a culture of safety, and has many elements including open communication with patients and families, colleagues, and organizations about problems. While fear of litigation is a frequent concern when clinicians are contemplating being open with a patient about something that went wrong, robust evidence suggests that transparency, when approached in a disciplined and thoughtful manner, can actually reduce the chances of lawsuits. Communication and Resolution Programs are structured processes that can support dentists in their response to problems in care. The Dental Patient Safety Foundation is another important resource all dentists should know about and partner with to improve their practice. We provide practical suggestions that dentists can apply to their practice now to reduce the chances of harm events happening and to be better prepared to respond effectively when harm events occur.

  PublisherOA PDFDOI

• Crowdsourced Feedback to Improve Resident Physician Error Disclosure Skills

  JAMA Network Open · 2024-08-07 · 9 citations

  articleOpen access

  Importance: Residents must prepare for effective communication with patients after medical errors. The video-based communication assessment (VCA) is software that plays video of a patient scenario, asks the physician to record what they would say, engages crowdsourced laypeople to rate audio recordings of physician responses, and presents feedback to physicians. Objective: To evaluate the effectiveness of VCA feedback in resident error disclosure skill training. Design, Setting, and Participants: This single-blinded, randomized clinical trial was conducted from July 2022 to May 2023 at 7 US internal medicine and family medicine residencies (10 total sites). Participants were second-year residents attending required teaching conferences. Data analysis was performed from July to December 2023. Intervention: Residents completed 2 VCA cases at time 1 and were randomized to the intervention, an individual feedback report provided in the VCA application after 2 weeks, or to control, in which feedback was not provided until after time 2. Residents completed 2 additional VCA cases after 4 weeks (time 2). Main Outcomes and Measures: Panels of crowdsourced laypeople rated recordings of residents disclosing simulated medical errors to create scores on a 5-point scale. Reports included learning points derived from layperson comments. Mean time 2 ratings were compared to test the hypothesis that residents who had access to feedback on their time 1 performance would score higher at time 2 than those without feedback access. Residents were surveyed about demographic characteristics, disclosure experience, and feedback use. The intervention's effect was examined using analysis of covariance. Results: A total of 146 residents (87 [60.0%] aged 25-29 years; 60 female [41.0%]) completed the time 1 VCA, and 103 (70.5%) completed the time 2 VCA (53 randomized to intervention and 50 randomized to control); of those, 28 (54.9%) reported reviewing their feedback. Analysis of covariance found a significant main effect of feedback between intervention and control groups at time 2 (mean [SD] score, 3.26 [0.45] vs 3.14 [0.39]; difference, 0.12; 95% CI, 0.08-0.48; P = .01). In post hoc comparisons restricted to residents without prior disclosure experience, intervention residents scored higher than those in the control group at time 2 (mean [SD] score, 3.33 [0.43] vs 3.09 [0.44]; difference, 0.24; 95% CI, 0.01-0.48; P = .007). Worse performance at time 1 was associated with increased likelihood of dropping out before time 2 (odds ratio, 2.89; 95% CI, 1.06-7.84; P = .04). Conclusions and Relevance: In this randomized clinical trial, self-directed review of crowdsourced feedback was associated with higher ratings of internal medicine and family medicine residents' error disclosure skill, particularly for those without real-life error disclosure experience, suggesting that such feedback may be an effective way for residency programs to address their requirement to prepare trainees for communicating with patients after medical harm. Trial Registration: ClinicalTrials.gov Identifier: NCT06234085.

  PublisherOA PDFDOI

Recent grants

• NIH Grant R01HS016506

  NIH · $872k · 2013

• NIH Grant R18HS019531

  NIH · $3.0M · 2014

• NIH Grant P20CA137219

  NIH · $14.9M · 2014

• NIH Grant K08HS014012

  NIH · $378k · 2007

• CRP Certification: Promoting Accountability and Learning After Adverse Events

  NIH · $722k · 2016–2020

Frequent coauthors

• Wendy Levinson

  University of Toronto

  52 shared

• Diane M. Korngiebel

  University of Washington Medical Center

  50 shared

• Cyan James

  49 shared

• Benjamin S. Wilfond

  University of Washington

  49 shared

• Douglas S. Diekema

  University of Washington

  49 shared

• Alexander Morgan Capron

  University of Southern California

  49 shared

• Stephanie A. Alessi

  Stanford University

  49 shared

• Sandra Soo‐Jin Lee

  Cal Humanities

  49 shared

Awards & honors

• John M. Eisenberg Patient Safety and Quality Award for Indiv…