Patients with medical injury sound off on hospital reaction

People who have experienced a medical injury need to be heard by clinicians and feel that the hospital is taking steps to address the issue, say researchers.

Senior law lecturer at UNSW Sydney Dr Jennifer Moore said this might involve listening to patients for a very long time and letting their priorities lead the conversation.

In the paper, Patients’ Experiences with Communication-and-Resolution Programs After Medical Injury, published in JAMA Internal Medicine, Moore and her fellow researchers said patients feel better when healthcare staff – especially the clinician who made the error – listen closely to what they have to say about the experience.

They also want to know what the hospital is doing to ensure the same mistake doesn’t happen again. Moore said: "It is not enough to take action to improve things; it is really important that the patient safety efforts are communicated to the patient and family."

Increasingly, US hospitals have turned to communication-and-resolution programs (CRPs) to handle cases of medical malpractice. In an interview with JAMA Internal Medicine, co-author professor Michelle Mello from Stanford University said the traditional approach to managing patients after a medical injury occurs is to hope they go away and say as little as possible but CRPs do the opposite. "They try to meet patient safety goals and liability cost-reduction goals by disclosing adverse events and errors to patients, rapidly investigating — even when the patient's not complaining about the care — offering an explanation of what was found [and] forwarding the case onto the insurer for consideration for proactive compensation."

Besides improving patient safety, reducing lawsuits and improving transparency around adverse events, Mello said CRPs support clinicians in their journey to disclose medical injuries effectively.

Moore said despite increasing interest in this approach, the JAMA study represents the first time that researchers were given permission to talk to US patients and family members about their experiences with CRPs. The team hoped to find out how patients and their families felt about the hospital's response after there had been a medical injury, and what find out what helped and hindered reconciliation.

Along with Dr Marie Bismark from the University of Melbourne, Mello and Moore interviewed 40 patients, family members and staff at three US hospitals that operate CRPs – Stanford Medical Center, Beth Israel Deaconess Medical Center (Harvard) and Baystate Hospital.

Just under two thirds of patient and family participants reported positive experiences with CRPs overall and continued to receive care at the hospital but they also said hospitals rarely communicated information about efforts to prevent recurrences.

While most participants said they were satisfied overall with the compensation portion of the program, when asked about the reasons for being less than fully satisfied, they noted the amount of money received but also indicated dissatisfaction with the process that led to that compensation offer. Mello told JAMA: "The hospitals really felt that they had been very proactive and assertive in trying to anticipate and meet patients' and families' needs. The families didn't feel that way a lot of the time.

"They felt that they had to wait longer than they should have to get compensation and that hospital hadn't done a particularly good job at anticipating things like the mortgage coming due at the end of the month."

They also felt that some of the collaborative, meaningfully emotional conversations that started out in the process when the error was disclosed did not continue into the compensation phase," she added. "As one patient put it, 'The gloves came off sometimes'."

The study’s authors said satisfaction was highest when communications were empathetic and nonadversarial, including compensation negotiations.

Mello said: "Hospitals that really achieved this goal of authentic, empathic communication with the patient, providing the information that patients needed ... and really being proactive, not just offering compensation but in thinking thoughtfully about what this family is going to need –  those were the types of things that communicated to patients 'this is still an institution that cares for us'."

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