Faculty of Law, University of New South Wales, Sydney, New South Wales, Australia.
Stanford Law School, Stanford University, Stanford, California, USA.
BMJ Qual Saf. 2017 Oct;26(10):788-798. doi: 10.1136/bmjqs-2016-005804. Epub 2017 Mar 9.
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 institution-led alternatives to malpractice litigation.
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.
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.
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.
尽管在新西兰（NZ）、英国和美国投入了大量资金来探索以患者为中心的医疗事故替代方案，但患者对这些方案的体验仍未得到充分了解。我们旨在探讨在患者安全事件后促进和阻碍和解的因素，并为加强机构主导的医疗事故诉讼替代方案提出建议。
我们对 NZ 62 名因医疗保健而受伤的患者、12 家公立医院的管理人员、5 名专门从事意外伤害赔偿公司（ACC）索赔的律师和 3 名 ACC 工作人员进行了半结构化访谈。选择 NZ 作为研究地点是因为它已经用无过错方案取代了医疗事故诉讼。使用主题分析从访谈记录中确定关键主题。
访谈回复集中在和解过程的五个要素上，这些要素非常重要：（1）询问而不是假设患者和家属对该过程的需求，并认识到对许多患者来说，被倾听是重要的，应该在和解过程的早期进行；（2）及时、真诚、文化上合适且有意义地支持道歉，避免被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者；（5）在适当情况下聘请律师和患者关系工作人员的支持。
政策制定者和医疗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；使用灵活的准则，提炼最佳实践原则，确保不会遗漏步骤，同时不规定“一刀切”的沟通方法。
