Patient and Family Involvement in Serious Incident Investigations From the Perspectives of Key Stakeholders: A Review of the Qualitative Evidence

Abstract

ObjectivesInvestigations of healthcare harm often overlook the valuable insights of patients and families. Our review aimed to explore the perspectives of key stakeholders when patients and families were involved in serious incident investigations.MethodsThe authors searched three databases (Medline, PsycInfo, and CINAHL) and Connected Papers software for qualitative studies in which patients and families were involved in serious incident investigations until no new articles were found.ResultsTwenty-seven papers were eligible. The perspectives of patients and families, healthcare professionals, nonclinical staff, and legal staff were sought across acute, mental health and maternity settings. Most patients and families valued being involved; however, it was important that investigations were flexible and sensitive to both clinical and emotional aspects of care to avoid compounding harm. This included the following: early active listening with empathy for trauma, sincere and timely apology, fostering trust and transparency, making realistic timelines clear, and establishing effective nonadversarial communication. Most staff perceived that patient and family involvement could improve investigation quality, promote an open culture, and help ensure future safety. However, it was made difficult when multidisciplinary input was absent, workload and staff turnover were high, training and support needs were unmet, and fears surrounded litigation. Potential solutions included enhancing the clarity of roles and responsibilities, adequately training staff, and providing long and short-term support to stakeholders.ConclusionsOur review provides insights to ensure patient and family involvement in serious incident investigations considers both clinical and emotional aspects of care, is meaningful for all key stakeholders, and avoids compounding harm. However, significant gaps in the literature remain.

Patient inclusion in case reports: a call to action

“…This suggests that access to appropriate senior support is made available after the event, and written communication with the patient's general practitioner may be appropriate [15]. However, a recent review of the evidence on key stakeholder perspectives when patients and families are involved in serious incident investigations indicates significant gaps in the literature [16]. It may be appropriate to talk to the patient soon after the episode of care described, but a time delay before a final version is written may be needed to allow for the patient to reflect.…”

Educational workshops for health care professionals on compassionate communication following adverse events in health care: a mixed method evaluation

“…Within NHS Scotland, a serious adverse event review (SAER) is required following an event that could have caused (a near miss), or did result in, harm to people or groups of people [1]. Evidence on the bene ts of including patients and families in adverse event reviews is clear yet in practice this does not always happen [2,3,4]. A collaborative, person-centred approach which listens to, and involves, patients and their families is likely to lead to improved outcomes when things have gone wrong in healthcare.…”

One size doesn’t always fit all: professional perspectives of serious incident management systems in mental healthcare

“…Cross-system incident investigations are now seen as a necessity, given the recognition that incidents often stem from weaknesses at the interface between agencies, particularly health and social care (NHSE and NHSI, 2020). However, multidisciplinary input and wider support to deliver effective investigations have been highlighted by staff as an unmet need (Ramsey et al , 2022). Therefore, the way investigations are conducted and their focus are significant determinants of identifying learning that can be applied to improve the safety of everyday practice.…”

“…The “duty” of candour, which is both a statutory and professional requirement, aims to make sure that those delivering care are open and transparent with those people accessing their services when incidents occur (Department of Health, 2014). It includes candour with patients, families and carers involved in incidents, as part of an effective patient safety system that is open to learning (Wood et al , 2023; Crane, 2001) and promotion of an open culture (Ramsey et al , 2022). Whilst engagement and involvement are current priorities for NHS trusts (NHSE, 2022b), we are not aware of any specific research on perceptions of the local infrastructures that are required to be able to support those adversely affected by incidents, particularly staff.…”