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      The struggle against perceived negligence. A qualitative study of patients’ experiences of adverse events in Norwegian hospitals

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          Abstract

          Background

          Every year, 14 % of patients in Norwegian hospitals experience adverse events, which often have health-damaging consequences. The government, hospital management and health personnel attempt to minimize such events. Limited research on the first-hand experience of the patients affected is available. The aim of this study is to present patients’ perspectives of the occurrence of, disclosure of, and healthcare organizations’ responses to adverse events. Findings are discussed within a social constructivist framework and with reference to principles of open disclosure policy.

          Methods

          This qualitative study with an explorative descriptive design included fifteen in-depth interviews with former patients recruited by the Health and Social Services ombudsmen in the two northernmost counties of Norway. Inclusion criteria were as follows: 1) experience of adverse events in connection with surgical, orthopedic or medical treatment in general hospitals; 2) men and women; 3) aged 20–70; and 4) a minimum of one year since the event occurred. Transcribed audio-recorded interviews were analyzed through qualitative content analysis.

          Results

          The analysis revealed three main topics regarding patients’ experiences of adverse events: 1) ignored concerns or signs of complications; 2) lack of responsibility and error correction; and 3) lack of support, loyalty and learning opportunities. Patients had to struggle to demonstrate the error that had occurred and to receive the necessary treatment and monitoring in the aftermath of the events.

          Conclusions

          Patient narratives reveal a lack of openness, care and responsibility in connection with adverse events. Conflicting power structures, attitudes and established procedures may inhibit prevention, learning and patient safety work in spite of major efforts and good intentions. Attitudes in day-to-day patient care and organizational procedures should be challenged to invite patients into open disclosure processes and include them in health and safety work to a greater extent. The study’s small sample of self-selected participants limits the generalizability of the findings, and future studies should include a larger number of patients as well as professional perspectives.

          Electronic supplementary material

          The online version of this article (10.1186/s12913-018-3101-2) contains supplementary material, which is available to authorized users.

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          Most cited references19

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          Medical error: the second victim. The doctor who makes the mistake needs help too.

          Albert Wu (2000)
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            Patient safety: what about the patient?

            Plans for improving safety in medical care often ignore the patient's perspective. The active role of patients in their care should be recognised and encouraged. Patients have a key role to play in helping to reach an accurate diagnosis, in deciding about appropriate treatment, in choosing an experienced and safe provider, in ensuring that treatment is appropriately administered, monitored and adhered to, and in identifying adverse events and taking appropriate action. They may experience considerable psychological trauma both as a result of an adverse outcome and through the way the incident is managed. If a medical injury occurs it is important to listen to the patient and/or the family, acknowledge the damage, give an honest and open explanation and an apology, ask about emotional trauma and anxieties about future treatment, and provide practical and financial help quickly.
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              Relation between malpractice claims and adverse events due to negligence. Results of the Harvard Medical Practice Study III.

              By matching the medical records of a random sample of 31,429 patients hospitalized in New York State in 1984 with statewide data on medical-malpractice claims, we identified patients who had filed claims against physicians and hospitals. These results were then compared with our findings, based on a review of the same medical records, regarding the incidence of injuries to patients caused by medical management (adverse events). We identified 47 malpractice claims among 30,195 patients' records located on our initial visits to the hospitals, and 4 claims among 580 additional records located during follow-up visits. The overall rate of claims per discharge (weighted) was 0.13 percent (95 percent confidence interval, 0.076 to 0.18 percent). Of the 280 patients who had adverse events caused by medical negligence as defined by the study protocol, 8 filed malpractice claims (weighted rate, 1.53 percent; 95 percent confidence interval, 0 to 3.2 percent). By contrast, our estimate of the statewide ratio of adverse events caused by negligence (27,179) to malpractice claims (3570) is 7.6 to 1. This relative frequency overstates the chances that a negligent adverse event will produce a claim, however, because most of the events for which claims were made in the sample did not meet our definition of adverse events due to negligence. Medical-malpractice litigation infrequently compensates patients injured by medical negligence and rarely identifies, and holds providers accountable for, substandard care.
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                Author and article information

                Contributors
                +47 78450634 , gunn.hagensen@uit.no
                +47 41565952 , gun025@post.uit.no
                +47 78450628 , grete.mehus@uit.no
                +47 77644859 , nils.henriksen@uit.no
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                25 April 2018
                25 April 2018
                2018
                : 18
                : 302
                Affiliations
                [1 ]ISNI 0000000122595234, GRID grid.10919.30, Department of Health and Care Sciences, , UiT The Arctic University of Norway, ; Hammerfest, Norway
                [2 ]ISNI 0000000122595234, GRID grid.10919.30, Department of Health and Care Sciences, , UiT The Arctic University of Norway, ; Tromsø, Norway
                Author information
                http://orcid.org/0000-0002-8332-5083
                Article
                3101
                10.1186/s12913-018-3101-2
                5921559
                29699556
                aed571b8-69b6-4df3-9d51-4298fd92bbad
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 6 May 2016
                : 8 April 2018
                Funding
                Funded by: UIT, the arctic university of Norway
                Award ID: 250110
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Health & Social care
                patient experience,medical errors/adverse events,open disclosure,patient safety

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