Office of Clinical Governance, Tan Tock Seng Hospital, Singapore, Singapore.
National Healthcare Group, Singapore, Singapore.
PLoS One. 2022 Oct 14;17(10):e0276124. doi: 10.1371/journal.pone.0276124. eCollection 2022.
The resource burden of healthcare disputes and medico-legal claims has been rising. A dispute resolution system operating at the hospital level could ameliorate this disturbing trend.
This is a retrospective observational study on patient complaints and medico-legal cases received by the dispute resolution unit of an acute tertiary hospital from 2011 to 2015. We described the characteristics and analysed the resolution methodology and outcomes of all closed medico-legal cases.
Patient complaints significantly increased at a compound annual growth rate (CAGR) of 4.2% (p<0.01), while medico-legal cases and ex-gratia payments for case settlements decreased at CAGRs of 4.8% (p<0.05) and 15.9% (p = 0.19), respectively. Out of 237 closed medico-legal cases, 88.6% were resolved without legal action, of which 78.1% were closed without any ex-gratia payments or waivers. Of the 11.4% of medico-legal cases that involved legal action, 66.7% were settled without ex-gratia payments or waivers. The primary resolution modes were the Patient Relations Service (PRS)'s engagement of the complainants and facilitation of written replies. No cases were brought to court. Cases were more likely resolved without legal action when there was engagement by the PRS (p = 0.009). These cases incurred a lower median settlement value than those with legal action.
Our hospital-based dispute resolution system which addressed patients' core dissatisfactions and providers' perspectives, through a process of early engagement, open disclosure, and fair negotiations, was able to promote claims resolution before legal action was taken. This early dispute resolution strategy contained costs and maintained provider-patient relationships and complements system-level mediation and arbitration to reduce medico-legal litigation.
医疗纠纷和医疗法律诉讼的资源负担一直在增加。在医院层面运作的纠纷解决系统可以改善这一令人不安的趋势。
这是一项对一家急性三级医院纠纷解决单位在 2011 年至 2015 年期间收到的患者投诉和医疗法律案件的回顾性观察研究。我们描述了所有已结案的医疗法律案件的特征，并分析了其解决方法和结果。
患者投诉以每年 4.2%的复合增长率（CAGR）显著增加（p<0.01），而医疗法律案件和为解决案件而支付的特别偿金则以每年 4.8%（p<0.05）和 15.9%（p = 0.19）的复合年增长率减少。在 237 例已结案的医疗法律案件中，88.6%无需法律诉讼即可解决，其中 78.1%无需支付特别偿金或豁免即可结案。在需要法律诉讼的 11.4%的医疗法律案件中，66.7%无需支付特别偿金或豁免即可解决。主要的解决方式是患者关系服务部（PRS）与投诉人接触并协助书面答复。没有案件被提交法院。当 PRS 参与（p = 0.009）时，案件更有可能无需法律诉讼即可解决。这些案件的解决费用中位数低于需要法律诉讼的案件。
我们的医院纠纷解决系统通过早期接触、公开披露和公平谈判来解决患者的核心不满和提供者的观点，从而能够在采取法律行动之前促进索赔解决。这种早期的纠纷解决策略控制了成本，维护了医患关系，并补充了系统层面的调解和仲裁，以减少医疗法律诉讼。
