Ramsey Lauren, Sheard Laura, Waring Justin, McHugh Siobhan, Simms-Ellis Ruth, Louch Gemma, Ludwin Katherine, O'Hara Jane K
Yorkshire and Humber Patient Safety Research Collaboration, Bradford Institute for Health Research, Bradford, United Kingdom.
York Trials Unit, University of York, York, United Kingdom.
Front Health Serv. 2025 Jan 3;4:1473256. doi: 10.3389/frhs.2024.1473256. eCollection 2024.
There is a growing international policy focus on involving those affected by healthcare safety incidents, in subsequent investigations. Nonetheless, there remains little UK-based evidence exploring how this relates to the experiences of those affected over time, including the factors influencing decisions to litigate.
We aimed to explore the experiences of patients, families, staff and legal representatives affected by safety incidents over time, and the factors influencing decisions to litigate.
Participants were purposively recruited via (i) communication from four NHS hospital Trusts or an independent national investigator in England, (ii) relevant charitable organizations, (iii) social media, and (iv) word of mouth to take part in a qualitative semi-structured interview study. Data were analyzed using an inductive reflexive thematic approach.
42 people with personal or professional experience of safety incident investigations participated, comprising patients and families ( = 18), healthcare staff ( = 7), legal staff ( = 1), and investigators ( = 16). Patients and families started investigation processes with cautious hope, but over time, came to realize that they lacked power, knowledge, and support to navigate the system, made clear in awaited investigation reports. Systemic fear of litigation not only failed to meet the needs of those affected, but also inadvertently led to some pursuing litigation. Staff had parallel experiences of exclusion, lacking support and feeling left with an incomplete narrative. Importantly, investigating was often perceived as a lonely, invisible and undervalued role involving skilled "work" with limited training, resources, and infrastructure. Ultimately, elusive "organizational agendas" were prioritized above the needs of all affected.
Incident investigations fail to acknowledge and address emotional distress experienced by all affected, resulting in compounded harm. To address this, we propose five key recommendations, to: (1) prioritize the needs of those affected by incidents, (2) overcome culturally engrained fears of litigation to re-humanize processes and reduce rates of unnecessary litigation, (3) recognize and value the emotionally laborious and skilled work of investigators (4) inform and support those affected, (5) proceed in ways that recognize and seek to reduce social inequities.
国际政策越来越关注让受医疗安全事件影响的人参与后续调查。尽管如此，英国仍缺乏证据来探究这与受影响者长期以来的经历有何关联，包括影响诉讼决定的因素。
我们旨在探究受安全事件影响的患者、家属、工作人员和法律代表长期以来的经历，以及影响诉讼决定的因素。
通过以下方式有目的地招募参与者：（i）来自英格兰四个国民保健服务医院信托机构或一名独立国家调查员的沟通；（ii）相关慈善组织；（iii）社交媒体；（iv）口碑相传，以参与一项定性半结构化访谈研究。使用归纳反思性主题方法对数据进行分析。
42名有安全事件调查个人或专业经验的人参与了研究，包括患者和家属（18人）、医护人员（7人）、法律人员（1人）和调查人员（16人）。患者和家属带着谨慎的希望启动调查程序，但随着时间的推移，他们意识到自己在应对该系统时缺乏权力、知识和支持，这在等待的调查报告中体现得很明显。对诉讼的系统性恐惧不仅未能满足受影响者的需求，还无意中导致一些人提起诉讼。工作人员也有类似的被排斥经历，缺乏支持，感觉留下了不完整的叙述。重要的是，调查往往被视为一项孤独、无形且被低估的工作，涉及技能性“工作”，但培训、资源和基础设施有限。最终，难以捉摸的“组织议程”被置于所有受影响者的需求之上。
事件调查未能承认并解决所有受影响者经历的情感困扰，导致伤害加剧。为解决这一问题，我们提出五项关键建议：（1）优先考虑受事件影响者的需求；（2）克服文化上根深蒂固的对诉讼的恐惧，使程序重新人性化并降低不必要的诉讼率；（3）认识并重视调查人员情感上费力且有技能的工作；（4）为受影响者提供信息并给予支持；（5）以认识并寻求减少社会不平等的方式开展工作。
