industry & policy
Listening to
reasons
Patients sound off on the way they were
treated by hospitals after a medical injury.
By Dallas Bastian
P
eople who have experienced a medical injury need to be
heard by clinicians and to feel that the hospital is taking
steps to address the issue, researchers say.
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 to the medical
injury, and to 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 the hospital hadn’t done a particularly
good job of 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 non-adversarial, 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 being thoughtful 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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