Communication-and-resolution programs (CRP) emphasize early disclosure of adverse events and proactive approaches to resolving the patient safety issue, but successful implementation has been challenging. This study used qualitative methods to explore factors supporting successful CRP implementation at two Massachusetts hospitals. Identified facilitators of successful implementation encompassed institutional leadership support including oversight by a full-time project manager, investments in physician training, positive relationships between hospital risk management and the liability insurer, use of formal decision protocols, collaborative group implementation, and small hospital size.