Today the hospital encourages employees to report mistakes, and also to report issues that might lead to mistakes. A committee of peers reviews serious incidents. If the panel determines that a mistake has occurred, the hospital and doctors apologize. In addition, the University of Michigan compensates the patient or the family.

The costs to such a review are high, said Mr. Boothman. They are included in the hospital's risk-management budget, which has grown to more than $3 million annually, up from $500,000 in 2001. But claims against the hospital have been reduced to 106 in 2008 from 121 in 2001.

Andrew Muth, an Ypsilanti, Mich., plaintiffs lawyer, said the hospital's project achieves the primary goal of litigation: getting to the truth quickly and efficiently.

In the second initiative, plaintiffs lawyers in participating states must retain medical experts who have practiced in the same specialty area as the physicians accused of malpractice.

These experts must file declarations that the injured parties have a reasonable basis to file suit.

The certificates can cost $5,000 or more each to produce because of the expense of hiring experts, say plaintiffs’ lawyers, who complain that the added burden can prevent some injured people from filing suit.

Write to Nathan Koppel at nathan.koppel@wsj.com and Barbara Martinez at Barbara.Martinez@wsj.com