Understanding the Severity of Wrongdoing in Health Care Delivery and Research: Lessons Learned From a Historiometric Study of 100 Cases

Abstract

Background Wrongdoing among physicians and researchers causes myriad problems for patients and research participants. While many articles have been published on professional wrongdoing, our literature review found no studies that examined the rich contextual details of large sets of historical cases of wrongdoing. Methods We examined 100 cases of wrongdoing in healthcare delivery and research using historiometric methods, which involve the statistical description and analysis of coded historical narratives. We used maximum variation, criterion-based sampling to identify cases involving 29 kinds of wrongdoing contained in a taxonomy of wrongdoing developed for the project. We coded the presence of a variety of environmental and wrongdoer variables and rated the severity of wrongdoing found in each case. This approach enabled us to (a) produce rich descriptions of variables characterizing cases; (b) identify factors influencing the severity of wrongdoing; and (c) test the hypothesis that professional wrongdoing is a unified, relatively homogenous phenomenon such as “organizational deviance.” Results Some variables were consistently found across cases (e.g., wrongdoers were male and cases lasted more than 2 years), and some variables were consistently absent across cases (e.g., cases did not involve wrongdoers who were mistreated by institutions or penalized for doing what is right). However, we also found that some variables associated with wrongdoing in research (such as ambiguous legal and ethical norms) differ from those associated with wrongdoing in healthcare delivery (such as wrongdoers with a significant history of professional misbehavior). Conclusions Earlier intervention from colleagues might help prevent the pattern we observed of repeated wrongdoing across multiple years. While some variables characterize the vast majority of highly publicized cases of wrongdoing in healthcare delivery and research—regardless of the kind of wrongdoing—it is important to examine and compare sets of relatively homogenous cases in order to identify factors associated with wrongdoing.

Understanding Research Misconduct: A Comparative Analysis of 120 Cases of Professional Wrongdoing

“…We decided to sample 40 cases of each kind of wrongdoing to create samples of equal size that, based on effect sizes observed in our past studies (DuBois et al, 2013b), would be large enough to detect significant differences if such differences existed.…”

“…Continuous variables (such age, date, number of sources consulted) were entered as such; bivariate variables (such as foreign-trained or evidence of insanity plea) were entered as yes/no; and scaled items were scored on a scale from 1 to 3 using a benchmark scoring guide described in DuBois et al (2013b). The meaning of the scale was defined for each variable, e.g., “1 = no evidence of conflicting roles; 2 = conflicting roles were played but managed; and 3 = conflicting roles were played and not managed.” The guide provides examples of each score for each variable.…”

“…For this dataset only one RA per case produced all ratings because we previously established very high inter-rater reliabilities (ICC = .84–1.0) for all scaled values using a set of 100 cases (DuBois et al, 2013b). …”

<p>Development and Psychometric Analysis of the Measure of Perceived Adherence to the Principles of Medical Ethics in Clinical Educational Settings: Trainee Version (PAMETHIC-CLIN-T)</p>

“…However, there is little consensus about the exact processes by which these ethical guidelines must be operationalized. 1 Taking the Hippocratic Oath by new medical graduates as a manifesto of their lifelong commitment to the associated ethical principles of the medical profession is widespread among medical educational institutions, 2,3 but there is plethora of research Correspondence: Abdolreza Shaghaghi Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz 51665-417, Iran Email shaghaghir@tbzmed.ac.ir evidence [4][5][6][7][8][9] to suggest recurrent pattern of deviance from these principles in healthcare delivery or medical education settings.…”

Preventing Egregious Ethical Violations in Medical Practice: Evidence-Informed Recommendations from a Multidisciplinary Working Group

“…Additionally, prior research by the team indicated that these forms of wrongdoing were sufficiently frequent to accrue at least 75 cases in each area of wrongdoing, which was necessary for purposes of statistical modeling. 16…”