@article {Moore788, author = {Jennifer Moore and Michelle M Mello}, title = {Improving reconciliation following medical injury: a qualitative study of responses to patient safety incidents in New Zealand}, volume = {26}, number = {10}, pages = {788--798}, year = {2017}, doi = {10.1136/bmjqs-2016-005804}, publisher = {BMJ Publishing Group Ltd}, abstract = {Background Despite the investment in exploring patient-centred alternatives to medical malpractice in New Zealand (NZ), the UK and the USA, patients{\textquoteright} 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 {\textquoteleft}one size fits all{\textquoteright} communication approach.}, issn = {2044-5415}, URL = {https://qualitysafety.bmj.com/content/26/10/788}, eprint = {https://qualitysafety.bmj.com/content/26/10/788.full.pdf}, journal = {BMJ Quality \& Safety} }