Patient race/ethnicity, age, gender and education are not related to preference for or response to disclosure

Antecedents, Consequences, and the Role of Third Parties in the Trust Repair Process: Evidence Taken from Orthodontics

Orthodontic treatment has popularized in Taiwan. Healthcare institutions can be responsive in their coping strategies and determine whether third-party intervention should take place involving medical disputes related to orthodontics in order to repair patient trust. This study draws on orthodontic treatment to explore the effect of various trust repair strategies employed by healthcare institutions and third-party involvement positively affecting outcomes related to trust repair. Patients were recruited among those who have undergone orthodontic treatments, and 353 valid scenario-based questionnaires were collected through an online survey. Results revealed that: (1) the affective and informational repair strategies positively impacted trust repair while the functional repair strategy did not; (2) trust repair positively impacted patient satisfaction/word-of-mouth and mediated between repair strategies and satisfaction/word-of-mouth; and (3) third-party involvement moderated the relationship between trust repair and word-of-mouth. The findings suggest that rather than receiving monetary compensation, patients usually prefer that healthcare institutions acknowledge their fault, offer apologies, and engage in active communications to clarify the causes of medical dispute. Further, an objective third party should be involved to mediate the medical disputes to afford satisfaction all around.

General Public's Attitudes Toward Disclosure of Patient Safety Incidents in Korea: Results of Disclosure of Patient Safety Incidents Survey I

Supplemental digital content is available in the text.

Objectives

Many countries and organizations have promoted the disclosure of patient safety incidents (DPSI). However, reporting frequency and quality of DPSI fall short of patient and caregiver' expectations. In this study, we examined the attitudes toward DPSI of the general public representing the Korean population.

Methods

Survey questions were developed based on a previous systematic review and qualitative research. Face-to-face interviews using paper-based questionnaires were conducted. We explored attitudes toward DPSI in various scenarios and opinions on methods to facilitate DPSI.

Results

Almost all participants answered that it is necessary to disclose major errors (99.9%) and near misses (93.3%). A total of 96.6% (675/699) agreed that “DPSI will lead physicians to pay more attention to patient safety in the future,” and 94.1% (658/699) agreed that “DPSI will make patients and their caregivers trust the physician more.” Although 79.7% (558/700) agreed that “apology law will limit patients' ability to prove physicians' negligence,” 95.4% (668/700) agreed with “I support the introduction of apology law.” Moreover, 90.6% (634/700) agreed with “I support the introduction of mandatory DPSI.”

Conclusions

This study showed the overwhelmingly positive attitude of the public toward DPSI. The positive opinion of the public about apology law suggests the possibility of introducing the disclosure policy coupled with legislation of apology law in South Korea.

Frequency, Expected Effects, Obstacles, and Facilitators of Disclosure of Patient Safety Incidents: A Systematic Review

Objectives

We performed a systematic review to assess and aggregate the available evidence on the frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents (DPSI).

Methods

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this systematic review and searched PubMed, Scopus, and the Cochrane Library for English articles published between 1990 and 2014. Two authors independently conducted the title screening and abstract review. Ninety-nine articles were selected for full-text reviews. One author extracted the data and another verified them.

Results

There was considerable variation in the reported frequency of DPSI among medical professionals. The main expected effects of DPSI were decreased intention of the general public to file medical lawsuits and punish medical professionals, increased credibility of medical professionals, increased intention of patients to revisit and recommend physicians or hospitals, higher ratings of quality of care, and alleviation of feelings of guilt among medical professionals. The obstacles to DPSI were fear of medical lawsuits and punishment, fear of a damaged professional reputation among colleagues and patients, diminished patient trust, the complexity of the situation, and the absence of a patient safety culture. However, the factors facilitating DPSI included the creation of a safe environment for reporting patient safety incidents, as well as guidelines and education for DPSI.

Conclusions

The reported frequency of the experience of the general public with DPSI was somewhat lower than the reported frequency of DPSI among medical professionals. Although we identified various expected effects of DPSI, more empirical evidence from real cases is required.

Which medical error to disclose to patients and by whom? Public preference and perceptions of norm and current practice

Background

Disclosure of near miss medical error (ME) and who should disclose ME to patients continue to be controversial. Further, available recommendations on disclosure of ME have emerged largely in Western culture; their suitability to Islamic/Arabic culture is not known.

Methods

We surveyed 902 individuals attending the outpatient's clinics of a tertiary care hospital in Saudi Arabia. Personal preference and perceptions of norm and current practice regarding which ME to be disclosed (5 options: don't disclose; disclose if associated with major, moderate, or minor harm; disclose near miss) and by whom (6 options: any employee, any physician, at-fault-physician, manager of at-fault-physician, medical director, or chief executive director) were explored.

Results

Mean (SD) age of respondents was 33.9 (10) year, 47% were males, 90% Saudis, 37% patients, 49% employed, and 61% with college or higher education. The percentage (95% confidence interval) of respondents who preferred to be informed of harmful ME, of near miss ME, or by at-fault physician were 60.0% (56.8 to 63.2), 35.5% (32.4 to 38.6), and 59.7% (56.5 to 63.0), respectively. Respectively, 68.2% (65.2 to 71.2) and 17.3% (14.7 to 19.8) believed that as currently practiced, harmful ME and near miss ME are disclosed, and 34.0% (30.7 to 37.4) that ME are disclosed by at-fault-physician. Distributions of perception of norm and preference were similar but significantly different from the distribution of perception of current practice (P < 0.001). In a forward stepwise regression analysis, older age, female gender, and being healthy predicted preference of disclosure of near miss ME, while younger age and male gender predicted preference of no-disclosure of ME. Female gender also predicted preferring disclosure by the at-fault-physician.

Conclusions

We conclude that: 1) there is a considerable diversity in preferences and perceptions of norm and current practice among respondents regarding which ME to be disclosed and by whom, 2) Distributions of preference and perception of norm were similar but significantly different from the distribution of perception of current practice, 3) most respondents preferred to be informed of ME and by at-fault physician, and 4) one third of respondents preferred to be informed of near-miss ME, with a higher percentage among females, older, and healthy individuals.

Patients' and family members' experiences of open disclosure following adverse events

OBJECTIVE

To explore patients' and family members' perceptions of Open Disclosure of adverse events that occurred during their health care.

DESIGN

We interviewed 23 people involved in adverse events and incident disclosure using a semi-structured, open-ended guide. We analyzed transcripts using thematic discourse analysis.

SETTING

Four States in Australia: New South Wales, Victoria, Queensland and South Australia.

STUDY PARTICIPANTS

Twenty-three participants were recruited as part of an evaluation of the Australian Open Disclosure pilot commissioned by the Australian Commission on Safety and Quality in Health Care.

RESULTS

All participants (except one) appreciated the opportunity to meet with staff and have the adverse event explained to them. Their accounts also reveal a number of concerns about how Open Disclosure is enacted: disclosure not occurring promptly or too informally; disclosure not being adequately followed up with tangible support or change in practice; staff not offering an apology, and disclosure not providing opportunities for consumers to meet with the staff originally involved in the adverse event.

ANALYSIS

of participants' accounts suggests that a combination of formal Open Disclosure, a full apology, and an offer of tangible support has a higher chance of gaining consumer satisfaction than if one or more of these components is absent.

CONCLUSIONS

Staff need to become more attuned in their disclosure communication to the victim s perceptions and experience of adverse events, to offer an appropriate apology, to support victims long-term as well as short-term, and to consider using consumers' insights into adverse events for the purpose of service improvement.