Ramsey Lauren, Hughes Joanne, Hazeldine Debra, Seddon Sarah, Gould Mary, Wailling Jo, Murray Jenni, McHugh Siobhan, Simms-Ellis Ruth, Halligan Daisy, Ludwin Katherine, O'Hara Jane K
Yorkshire and Humber Patient Safety Research Collaboration, Bradford Institute for Health Research, Bradford, United Kingdom.
Patient and Family Advisory Group, University of Leeds, Leeds, United Kingdom.
Front Health Serv. 2024 Dec 17;4:1473296. doi: 10.3389/frhs.2024.1473296. eCollection 2024.
Healthcare organisations risk harming patients and their families twofold. First, through the physical, emotional and/or financial harm caused by safety incidents themselves, and second, through the organisational response to incidents. The former is well-researched and targeted by interventions. However, the latter, termed 'compounded harm' is rarely acknowledged.
We aimed to explore the ways compounded harm is experienced by patients and their families as a result of organisational responses to safety incidents and propose how this may be reduced in practice.
We used framework analysis to qualitatively explore data derived from interviews with 42 people with lived or professional experience of safety incident responses. This comprised 18 patients/relatives, 16 investigators, seven healthcare staff and one legal staff. People with lived and professional experience also helped to shape the design, conduct and findings of this study.
We identified six ways that patients and their families experienced compounded harm because of incident responses. These were feeling: (1) powerless, (2) inconsequential, (3) manipulated, (4) abandoned, (5) de-humanised and (6) disoriented.
It is imperative to reduce compounded harm experienced by patients and families. We propose three recommendations for policy and practice: (1) the healthcare system to recognise and address epistemic injustice and equitably support people to be equal partners throughout investigations and subsequent learning to reduce the likelihood of patients and families feeling powerless and inconsequential; (2) honest and transparent regulatory and organisational cultures to be fostered and enacted to reduce the likelihood of patients and families feeling manipulated; and (3) the healthcare system to reorient towards providing restorative responses to harm which are human centred, relational and underpinned by dignity, safety and voluntariness to reduce the likelihood of patients and families feeling abandoned, de-humanised and disoriented.
医疗保健机构有双重风险会伤害患者及其家属。其一，安全事件本身会造成身体、情感和/或经济伤害；其二，机构对事件的应对方式也会造成伤害。前者已有充分研究并通过干预措施加以解决。然而，后者即所谓的“复合伤害”却很少得到承认。
我们旨在探究患者及其家属因机构对安全事件的应对而遭受复合伤害的方式，并提出在实践中如何减少这种伤害。
我们采用框架分析法对42位有安全事件应对亲身经历或专业经验的人员的访谈数据进行定性研究。其中包括18位患者/亲属、16位调查人员、7位医护人员和1位法律人员。有亲身经历和专业经验的人员也协助塑造了本研究的设计、实施和结果。
我们确定了患者及其家属因事件应对而遭受复合伤害的六种方式。这些感受包括：（1）无力感，（2）无足轻重感，（3）被操纵感，（4）被遗弃感，（5）被剥夺人性感，（6）迷失方向感。
减少患者和家属遭受的复合伤害势在必行。我们针对政策和实践提出三项建议：（1）医疗保健系统应认识并解决认知不公正问题，并在整个调查及后续学习过程中公平地支持人们成为平等的合作伙伴，以减少患者和家属产生无力感和无足轻重感的可能性；（2）营造并践行诚实透明的监管和组织文化，以减少患者和家属产生被操纵感的可能性；（3）医疗保健系统应重新定位，提供以恢复性为导向的伤害应对措施，这些措施应以患者为中心、注重人际关系，并以尊严、安全和自愿为基础，以减少患者和家属产生被遗弃感、被剥夺人性感和迷失方向感的可能性。
