The Controlled Risk Insurance Company (CRICO), organized in 1976, has been functioning as the malpractice captive for the Harvard teaching institutions for more than three decades. While its initial mission was to assert greater control over the defense of legal cases, a broader goal soon emerged: as malpractice cases were being deeply analyzed for defensibility purposes, learnings were being generated that had the potential of interrupting—even halting—the cycles of malpractice issues. Hence CRICO’s loss prevention program was born, and in 1979, CRICO’s Risk Management Foundation (RMF) began to administer it.

Today, CRICO⁄RMF provides both malpractice defense and loss prevention services to more than 11,500 attending physicians, resident physicians, and fellows who practice medicine and ⁄ or provide clinical care at 25 health care entities in the greater Boston area. Although a relatively small number of 200–250 malpractice cases are asserted annually against physicians and institutions in the Harvard system, CRICO⁄ RMF’s reach is far more expansive through its loss prevention program. Built on a firm belief that malpractice events represent the ‘‘tip of the iceberg,’’ causation themes from litigation are bridged over to similar vulnerabilities that are continuing to take place in the present- tense environment. This meshing of the past with the present serves to identify where institutions remain vulnerable to preventable patient injuries and which quality improvement initiatives should take the highest priority.