Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 147 No. 1718 (2017)

What constitutes “competent error disclosure”? Insights from a national focus group study in Switzerland

  • Annegret F. Hannawa
DOI
https://doi.org/10.4414/smw.2017.14427
Cite this as:
Swiss Med Wkly. 2017;147:w14427
Published
02.05.2017

Summary

The question is no longer whether to disclose an error to a patient. Many studies have established that medical errors are co-owned by providers and patients and thus must be disclosed. However, little evidence is available on the concrete communication skills and contextual features that contribute to patients’ perceptions of “competent disclosures” as a key predictor of objective disclosure outcomes. This study operationalises a communication science model to empirically characterise what messages, behaviours and contextual factors Swiss patients commonly consider “competent” during medical error disclosures, and what symptoms and behaviours they experience in response to competent and incompetent disclosures. For this purpose, ten focus groups were conducted at five hospitals across Switzerland. Sixty-three patients participated in the meetings. Qualitative analysis of the focus group transcripts revealed concrete patient expectations regarding provider’s motivations, knowledge and skills. The analysis also illuminated under what circumstances to disclose, what to disclose, how to disclose and the effects of competent and incompetent disclosures on patients’ symptoms and behaviours. Patients expected that providers enter a disclosure informed and with approach-oriented motivations. In line with previous research, they preferred a remorseful declaration of responsibility and apology, a clear and honest account, and a discussion of reparation and future forbearance. Patients expected providers to display attentiveness, composure, coordination, expressiveness and interpersonal adaptability as core communication skills. Furthermore, numerous functional, relational, chronological and environmental contextual considerations evolved as critical features of competent disclosures. While patients agreed on a number of preferences, there is no one-size-fits-all approach to competent disclosures. Thus, error disclosures do not lend themselves to a checklist approach. Instead, this study provides concrete evidence-based starting points for the development of a disclosure training that is grounded in a communication science model, aiming to support clinicians, institutions and patients with this challenging task.

References

  1. National Quality Forum. Safe Practices for Better Healthcare–2009 Update: A Consensus Report. Washington, DC: NQF; 2009.
  2. The Joint Commission. Comprehensive accreditation manual. CAMH for hospitals: the official handbook. Oakbrook Terrace, IL: Joint Commission; 2010.
  3. Evans SB, Yu JB, Chagpar A. How radiation oncologists would disclose errors: results of a survey of radiation oncologists and trainees. Int J Radiat Oncol Biol Phys. 2012;84(2):e131–7. https://doi.org/10.1016/j.ijrobp.2012.03.010
  4. Mazor KM, Simon SR, Yood RA, Martinson BC, Gunter MJ, Reed GW, et al. Health plan members’ views about disclosure of medical errors. Ann Intern Med. 2004;140(6):409–18. https://doi.org/10.7326/0003-4819-140-6-200403160-00006
  5. Gallagher TH, Waterman AD, Ebers AG, Fraser VJ, Levinson W. Patients’ and physicians’ attitudes regarding the disclosure of medical errors. JAMA. 2003;289(8):1001–7. https://doi.org/10.1001/jama.289.8.1001
  6. Hammami MM, Attalah S, Al Qadire M. Which medical error to disclose to patients and by whom? Public preference and perceptions of norm and current practice. BMC Med Ethics. 2010;11(1):17. https://doi.org/10.1186/1472-6939-11-17
  7. Hingorani M, Wong T, Vafidis G. Attitudes after unintended injury during treatment a survey of doctors and patients. West J Med. 1999;171(2):81–2.
  8. Ushie BA, Salami KK, Jegede AS, Oyetunde M. Patients’ knowledge and perceived reactions to medical errors in a tertiary health facility in Nigeria. Afr Health Sci. 2013;13(3):820–8.
  9. Witman AB, Park DM, Hardin SB. How do patients want physicians to handle mistakes? A survey of internal medicine patients in an academic setting. Arch Intern Med. 1996;156(22):2565–9. https://doi.org/10.1001/archinte.1996.00440210083008
  10. Hobgood C, Peck CR, Gilbert B, Chappell K, Zou B. Medical errors-what and when: what do patients want to know? Acad Emerg Med. 2002;9(11):1156–61.
  11. Blendon RJ, DesRoches CM, Brodie M, Benson JM, Rosen AB, Schneider E, et al. Views of practicing physicians and the public on medical errors. N Engl J Med. 2002;347(24):1933–40. https://doi.org/10.1056/NEJMsa022151
  12. Mazor KM, Goff SL, Dodd K, Alper EJ. Understanding patients’ perceptions of medical errors. J Commun Healthc. 2009;2(1):34–46. https://doi.org/10.1179/cih.2009.2.1.34
  13. Bismark M, Dauer E, Paterson R, Studdert D. Accountability sought by patients following adverse events from medical care: the New Zealand experience. CMAJ. 2006;175(8):889–94. https://doi.org/10.1503/cmaj.060429
  14. Wu AW, Huang I-C, Stokes S, Pronovost PJ. Disclosing medical errors to patients: it’s not what you say, it’s what they hear. J Gen Intern Med. 2009;24(9):1012–7. https://doi.org/10.1007/s11606-009-1044-3
  15. Hobgood C, Tamayo-Sarver JH, Elms A, Weiner B. Parental preferences for error disclosure, reporting, and legal action after medical error in the care of their children. Pediatrics. 2005;116(6):1276–86. https://doi.org/10.1542/peds.2005-0946
  16. The Kaiser Family Foundation, Agency for Healthcare Research and Quality. 2006 Update on Consumers’ Views of Patient Safety and Quality Information. 2006. Available from: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7819.pdf
  17. Espin S, Levinson W, Regehr G, Baker GR, Lingard L. Error or “act of God”? A study of patients’ and operating room team members’ perceptions of error definition, reporting, and disclosure. Surgery. 2006;139(1):6–14. https://doi.org/10.1016/j.surg.2005.07.023
  18. White AA, Gallagher TH, Krauss MJ, Garbutt J, Waterman AD, Dunagan WC, et al. The attitudes and experiences of trainees regarding disclosing medical errors to patients. Acad Med. 2008;83(3):250–6. https://doi.org/10.1097/ACM.0b013e3181636e96
  19. Iedema R, Allen S, Britton K, Piper D, Baker A, Grbich C, et al. Patients’ and family members’ views on how clinicians enact and how they should enact incident disclosure: the “100 patient stories” qualitative study. BMJ. 2011;343(jul25 1):d4423. https://doi.org/10.1136/bmj.d4423
  20. Hannawa AF. “Explicitly implicit”: examining the importance of physician nonverbal involvement during error disclosures. Swiss Med Wkly. 2012;142:w13576.
  21. Hannawa AF. Disclosing medical errors to patients: effects of nonverbal involvement. Patient Educ Couns. 2014;94(3):310–3. https://doi.org/10.1016/j.pec.2013.11.007
  22. Hannawa AF, Shigemoto Y, Little TD. Medical errors: Disclosure styles, interpersonal forgiveness, and outcomes. Soc Sci Med. 2016;156:29–38. https://doi.org/10.1016/j.socscimed.2016.03.026
  23. Lander LI, Connor JA, Shah RK, Kentala E, Healy GB, Roberson DW. Otolaryngologists’ responses to errors and adverse events. Laryngoscope. 2006;116(7):1114–20. https://doi.org/10.1097/01.mlg.0000224493.81115.57
  24. Kaldjian LC, Jones EW, Wu BJ, Forman-Hoffman VL, Levi BH, Rosenthal GE. Disclosing medical errors to patients: attitudes and practices of physicians and trainees. J Gen Intern Med. 2007;22(7):988–96. https://doi.org/10.1007/s11606-007-0227-z
  25. Wu AW, Boyle DJ, Wallace G, Mazor KM. Disclosure of adverse events in the United States and Canada: an update, and a proposed framework for improvement. J Public Health Res. 2013;2(3):e32. https://doi.org/10.4081/jphr.2013.e32
  26. Chan DK, Gallagher TH, Reznick R, Levinson W. How surgeons disclose medical errors to patients: a study using standardized patients. Surgery. 2005;138(5):851–8. https://doi.org/10.1016/j.surg.2005.04.015
  27. Mazor KM, Greene SM, Roblin D, Lemay CA, Firneno CL, Calvi J, et al. More than words: patients’ views on apology and disclosure when things go wrong in cancer care. Patient Educ Couns. 2013;90(3):341–6. https://doi.org/10.1016/j.pec.2011.07.010
  28. Hannawa AF. Shedding light on the dark side of doctor-patient interactions: verbal and nonverbal messages physicians communicate during error disclosures. Patient Educ Couns. 2011;84(3):344–51. https://doi.org/10.1016/j.pec.2011.04.030
  29. Vincent C, Young M, Phillips A. Why do people sue doctors? A study of patients and relatives taking legal action. Lancet. 1994;343(8913):1609–13. https://doi.org/10.1016/S0140-6736(94)93062-7
  30. Hickson GB, Clayton EW, Githens PB, Sloan FA. Factors that prompted families to file medical malpractice claims following perinatal injuries. JAMA. 1992;267(10):1359–63. https://doi.org/10.1001/jama.1992.03480100065032
  31. Spitzberg BH. Axioms for a theory of intercultural communication competence. Annu Rev Engl Learn Teach. 2009;14:69–81.
  32. Krippendorff K. Content analysis: An introduction to its methodology. Thousand Oaks, CA: Sage; 2013.
  33. Spitzberg BH. The tactical topography of stalking victimization and management. Trauma Violence Abuse. 2002;3(4):261–88. https://doi.org/10.1177/1524838002237330
  34. The Conceptual Framework for the International Classification for Patient Safety. Version 1.1 Final Technical Report. Geneva: World Health Organization World Alliance for Patient Safety; 2009.
  35. Keatings M, Martin M, McCallum A, Lewis J. Medical errors: understanding the parent’s perspective. Pediatr Clin North Am. 2006;53(6):1079–89. https://doi.org/10.1016/j.pcl.2006.09.004
  36. Department of Health. Making Amends: A Consultation Paper Setting Out Proposals for Reforming the Approach to Clinical Negligence in the NHS. A Report by the Chief Medical Officer. London: Stationery Office, 2003.
  37. Duclos CW, Eichler M, Taylor L, Quintela J, Main DS, Pace W, et al. Patient perspectives of patient-provider communication after adverse events. Int J Qual Health Care. 2005;17(6):479–86. https://doi.org/10.1093/intqhc/mzi065
  38. Berlinger N. Avoiding cheap grace. Medical harm, patient safety, and the culture(s) of forgiveness. Hastings Cent Rep. 2003;33(6):28–36. https://doi.org/10.2307/3527823
  39. Wu AW. Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ. 2000;320(7237):726–7. https://doi.org/10.1136/bmj.320.7237.726