Renkema Erik, Broekhuis Manda, Ahaus Kees
University of Groningen, Faculty of Economics and Business, Operations Department, P,O, Box 800, 9700, AV Groningen, The Netherlands.
BMC Health Serv Res. 2014 Jan 25;14:38. doi: 10.1186/1472-6963-14-38.
Practicing safe behavior regarding patients is an intrinsic part of a physician's ethical and professional standards. Despite this, physicians practice behaviors that run counter to patient safety, including practicing defensive medicine, failing to report incidents, and hesitating to disclose incidents to patients. Physicians' risk of malpractice litigation seems to be a relevant factor affecting these behaviors. The objective of this study was to identify conditions that influence the relationship between malpractice litigation risk and physicians' behaviors.
We carried out an exploratory field study, consisting of 22 in-depth interviews with stakeholders in the malpractice litigation process: five physicians, two hospital board members, five patient safety staff members from hospitals, three representatives from governmental healthcare bodies, three healthcare law specialists, two managing directors from insurance companies, one representative from a patient organization, and one representative from a physician organization. We analyzed the comments of the participants to find conditions that influence the relationship by developing codes and themes using a grounded approach.
We identified four factors that could affect the relationship between malpractice litigation risk and physicians' behaviors that run counter to patient safety: complexity of care, discussing incidents with colleagues, personalized responsibility, and hospitals' response to physicians following incidents.
In complex care settings procedures should be put in place for how incidents will be discussed, reported and disclosed. The lack of such procedures can lead to the shift and off-loading of responsibilities, and the failure to report and disclose incidents. Hospital managers and healthcare professionals should take these implications of complexity into account, to create a supportive and blame-free environment. Physicians need to know that they can rely on the hospital management after reporting an incident. To create realistic care expectations, patients and the general public also need to be better informed about the complexity and risks of providing health care.
践行对患者的安全行为是医生道德和职业标准的内在组成部分。尽管如此，医生仍会做出与患者安全相悖的行为，包括实施防御性医疗、不报告事件以及不愿向患者披露事件。医生面临医疗事故诉讼的风险似乎是影响这些行为的一个相关因素。本研究的目的是确定影响医疗事故诉讼风险与医生行为之间关系的条件。
我们开展了一项探索性实地研究，对医疗事故诉讼过程中的利益相关者进行了22次深入访谈：五位医生、两位医院董事会成员、五名医院患者安全工作人员、三名政府医疗保健机构代表、三名医疗保健法律专家、两名保险公司总经理、一名患者组织代表和一名医生组织代表。我们通过扎根方法制定代码和主题，分析参与者的评论以找出影响这种关系的条件。
我们确定了四个可能影响医疗事故诉讼风险与医生违背患者安全行为之间关系的因素：护理的复杂性、与同事讨论事件、个人责任以及医院在事件发生后对医生的反应。
在复杂的护理环境中，应制定关于如何讨论、报告和披露事件的程序。缺乏此类程序可能导致责任转移和推诿，以及事件报告和披露的失败。医院管理人员和医疗专业人员应考虑到复杂性的这些影响，营造一个支持性且无指责的环境。医生需要知道在报告事件后他们可以依赖医院管理层。为了建立现实的护理期望，患者和公众也需要更好地了解提供医疗保健的复杂性和风险。
