Improving reconciliation following medical injury: a qualitative study of responses to patient safety incidents in New Zealand
Improving reconciliation following medical injury: a qualitative study of responses to patient safety incidents in New Zealand
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DOI：
10.1136/bmjqs-2016-005804
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发表时间：
2017-10-01
影响因子：
5.4
通讯作者：
Mello, Michelle M.
中科院分区：
文献类型：
--
作者：
Moore, Jennifer;Mello, Michelle M.
背景尽管在新西兰、英国和美国都在投资探索以患者为中心的医疗事故替代方案，但患者在这些过程中的经历并没有得到很好的理解。我们试图探索因素，促进和阻碍和解后，病人的安全事故，并确定建议加强制度化的替代医疗事故lawying.Methods我们进行了半结构化的采访，62名受伤的病人在新西兰，12家公立医院的管理人员，5名律师专门在事故赔偿公司（ACC）索赔和3 ACC工作人员。新西兰被选为研究地点，因为它已取代医疗事故诉讼与无过错计划。主题分析被用来确定关键的主题，从访谈transcript.Results的采访回应收敛在和解过程中的五个要素是重要的：（1）问，而不是假设，什么病人和家属需要从这个过程中，并认识到，对许多病人来说，被听到是重要的，应该发生在和解过程的早期;（2）支持及时、真诚、文化上适当和有意义的道歉，避免强迫或象征性的准道歉;（3）选择促进和解的词语;（4）包括患者希望参与和解讨论的人，包括参与伤害事件的从业人员;以及（5）酌情寻求律师和患者关系工作人员的支持。讨论政策制定者和医疗保健机构对解决医疗事故的非诉讼方法非常感兴趣。对参与患者安全事件和解过程的参与者进行的访谈表明，医疗机构不应将道歉视为其他补救措施的替代品;使用灵活的指导方针，遵循最佳实践原则，确保不遗漏步骤，同时不规定“一刀切”的沟通方法。
Background Despite the investment in exploring patient-centred alternatives to medical malpractice in New Zealand (NZ), the UK and the USA, patients' experiences with these processes are not well understood. We sought to explore factors that facilitate and impede reconciliation following patient safety incidents and identify recommendations for strengthening institutionled alternatives to malpractice litigation.Methods We conducted semistructured interviews with 62 patients injured by healthcare in NZ, administrators of 12 public hospitals, 5 lawyers specialising in Accident Compensation Corporation (ACC) claims and 3 ACC staff. NZ was chosen as the research site because it has replaced medical malpractice litigation with a no-fault scheme. Thematic analysis was used to identify key themes from interview transcripts.Results Interview responses converged on five elements of the reconciliation process that were important: (1) ask, rather than assume, what patients and families need from the process and recognise that, for many patients, being heard is important and should occur early in the reconciliation process; (2) support timely, sincere, culturally appropriate and meaningful apologies, avoiding forced or tokenistic quasi-apologies; (3) choose words that promote reconciliation; (4) include the people who patients want involved in the reconciliation discussion, including practitioners involved in the harm event; and (5) engage the support of lawyers and patient relations staff as appropriate.Discussion Policymakers and healthcare institutions are keenly interested in non-litigation approaches to resolving malpractice incidents. Interviewing participants involved in patient safety incident reconciliation processes suggests that healthcare institutions should not view apology as a substitute for other remedial actions; use flexible guidelines that distil best-practice principles, ensuring that steps are not missed, while not prescribing a 'one size fits all' communication approach.