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Original Investigation
October 9, 2017

Patients’ Experiences With Communication-and-Resolution Programs After Medical Injury

Author Affiliations
  • 1Faculty of Law, University of New South Wales, Sydney, Australia
  • 2School of Population and Global Health, University of Melbourne, Melbourne, Australia
  • 3Stanford Law School, Stanford University, Stanford, California
  • 4Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
JAMA Intern Med. Published online October 9, 2017. doi:10.1001/jamainternmed.2017.4002
Key Points

Question  Do patients’ and families’ experiences with communication-and-resolution programs suggest aspects of institutional responses to injury that could better promote reconciliation after medical injuries?

Findings  This interview study of 40 patients, family members, and hospital staff found that patients have a strong need to be heard after medical injury that is often unmet. Although 18 of 30 patient and family participants (60%) reported positive experiences with communication-and-resolution programs overall and continued to receive care at the hospital, they reported that hospitals rarely communicated information about efforts to prevent recurrences.

Meaning  Opportunities are available to provide institutional responses to medical injuries that are more patient centered.

Abstract

Importance  Dissatisfaction with medical malpractice litigation has stimulated interest by health care organizations in developing alternatives to meet patients’ needs after medical injury. In communication-and-resolution programs (CRPs), hospitals and liability insurers communicate with patients about adverse events, use investigation findings to improve patient safety, and offer compensation when substandard care caused harm. Despite increasing interest in this approach, little is known about patients’ and family members’ experiences with CRPs.

Objective  To explore the experiences of patients and family members with medical injuries and CRPs to understand different aspects of institutional responses to injury that promoted and impeded reconciliation.

Design, Setting, and Participants  From January 6 through June 30, 2016, semistructured interviews were conducted with patients (n = 27), family members (n = 3), and staff (n = 10) at 3 US hospitals that operate CRPs. Patients and families were eligible for participation if they experienced a CRP, spoke English, and could no longer file a malpractice claim because they had accepted a settlement or the statute of limitations had expired. The CRP administrators identified hospital and insurer staff who had been involved in a CRP event and had a close relationship with the injured patient and/or family. They identified patients and families by applying the inclusion criteria to their CRP databases. Of 66 possible participants, 40 interviews (61%) were completed, including 30 of 50 invited patients and families (60%) and 10 of 16 invited staff (63%).

Main Outcomes and Measures  Patients’ reported satisfaction with disclosure and reconciliation efforts made by hospitals.

Results  A total of 40 participants completed interviews (15 men and 25 women; mean [range] age, 46 [18-67] years). Among the 30 patients and family members interviewed, 27 patients experienced injuries attributed to error and received compensation. The CRP experience was positive overall for 18 of the 30 patients and family members, and 18 patients continued to receive care at the hospital. Satisfaction was highest when communications were empathetic and nonadversarial, including compensation negotiations. Patients and families expressed a strong need to be heard and expected the attending physician to listen without interrupting during conversations about the event. Thirty-five of the 40 respondents believed that including plaintiffs’ attorneys in these discussions was helpful. Sixteen of the 30 patients and family members deemed their compensation to be adequate but 17 reported that the offer was not sufficiently proactive. Patients and families strongly desired to know what the hospital did to prevent recurrences of the event, but 24 of 30 reported receiving no information about safety improvement efforts.

Conclusions and Relevance  As hospitals strive to provide more patient-centered care, opportunities exist to improve institutional responses to injuries and promote reconciliation.

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