Adverse event reviews in healthcare: What matters to patients and their family? A qualitative study exploring the perspective of patients and family

Abstract

ObjectivesExplore what ‘good’ patient and family involvement in healthcare adverse event reviews may involve.DesignData was collected using semi-structured telephone interviews. Interview transcripts were analysed using an inductive thematic approach.SettingNHS Scotland.Participants19 interviews were conducted with patients who had experienced an adverse event during the provision of their healthcare, or their family member.ResultsFour key themes were derived from these interviews: trauma, communication, learning and litigation.ConclusionsFindings suggest there are many advantages of actively involving patients and their families in adverse event reviews. An open, collaborative, person-centred approach which listens to, and involves, patients and their families is perceived to lead to improved outcomes for all. For the patient and their family, it can help with reconciliation following a traumatic event and help restore their faith in the healthcare system. For the health service, listening and involving people will likely enhance learning with subsequent improvements in healthcare provision with reduction in risk of similar events occurring for other patients. Communicating in a compassionate manner could also decrease litigation claims following an adverse event. Overall, having personalised conversations and a streamlined review process, with open engagement to enhance learning, was important to most participants in this study.

Patient, carer and family experiences of seeking redress and reconciliation following a life‐changing event: Systematic review of qualitative evidence

“…18-20,22,23,25,27,29-32,34-36,38,39,42-44, 47-61,63-65,68-78 The most common countries where studies were conducted included the United States of America (n = 12), 27,30,31,38,39,43,51,52,58,59,64,68,71,72 Australia (n = 8) 19,22,29,34-36, 41,54,61,65,69,74 and the United Kingdom (n = 9). 18,20,25,48,55,57,[76][77][78] Adverse events occurred within following fields: medical (n = 31), 19,23,31,32,[34][35][36]43,44,[47][48][49][50][51][52][53][54][55][56][57][58][59][60]63,65,…”

“…done to ensure it does not happen again. 20,25,27,32,[34][35][36]38,39,[42][43][44]47,[49][50][51][52][53][54][55][58][59][60][61]65,[68][69][70][71][72][74][75][76][77][78] I needed to find out everything that went on, how it went on, how they was Perceived transparency of, and trust within, the redressreconciliation process can be enhanced if it is easy to access information about the event, how to access the redress-reconciliation process itself and justice-seekers' rights within it. The extent to which justice-seekers are signposted to the information and support they need can also support this.…”

“…(Patient-Complained about treatment following painful invasive investigation, Martin 57, p.4 ) Other systemic factors may influence decision-making within, and thus the perceived transparency and fairness of, the justiceseeking process. 23,25,27,29,30,42,[55][56][57]59,60,70,[75][76][77][78] The availability of…”

“…The outcomes sought through redress-reconciliation processes varied. 18,20,25,27,[29][30][31][32][34][35][36]38,39,[42][43][44]47,48,[50][51][52][53][54][55][56][57][58][59][60][61][63][64][65][68][69][70][71][72][74][75][76][77][78] Key outcomes included receiving answers to their questions and receipt of an apology, incorporating expressions of remorse and an admission of responsibility, accompanied by actions to assure them that the harm would not happen again and that future health and financial needs will be met.…”

“…Justice-seekers need to be supported to access and maintain engagement with a preplanned, consistent process that centres around their needs. 18,22,25,27,[29][30][31][32][34][35][36]42,44,[47][48][49][50][51][52][53][54][55][56][57][58][59][60][61]65,68,[74][75][76][77] Trust in the redress-reconciliation process may be enhanced by using a formal pathway which promotes a two-way dialogue between professional stakeholders and those who have experienced harm.…”