Background 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.
Methods 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.
Results 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.
Discussion 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.
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Contributors JM and MMM developed the study idea and conducted the analyses. JM conducted the interviews and wrote the first draft of the manuscript. MMM helped revise the draft manuscript. Both authors reviewed and agreed on the submitted version of the manuscript.
Funding The Commonwealth Fund, a private independent foundation based in New York City.
Disclaimer The views presented here are those of the authors and not necessarily those of The Commonwealth Fund, its directors, officers or staff.
Competing interests None declared.
Ethics approval University of Otago Human Research Subjects Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Following standard practice in this type of sensitive research with injured patients, we promised participants that their data would remain confidential. Specifically, the standardised information sheet we were required to distribute by the University of Otago's Human Subject Research Ethics Committee's states that only the researchers will have access to the data. Absent informed consent, we are not able to make the data broadly available. Should the reviewers or editors have questions about the validity of our data analysis or conclusions, however, we will of course do whatever we can to provide the information necessary to allay these concerns, short of violating our promises to participants.
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