To identify self-reported reasons that prompt families to file malpractice claims following perinatal injuries.
Families were interviewed by telephone using a questionnaire that contained structured and open-ended questions.
Mothers of infants who had experienced permanent injuries or deaths and had closed malpractice claims in Florida between 1986 and August 1989 were interviewed. Questionnaires were completed by 127 (35%) of a total of 368 such families.
Reasons prompting families to file and families' descriptions of medical events, advice from acquaintances, and the quality of physician-family communication.
Families volunteered numerous reasons for filing: advised by knowledgeable acquaintances (33% of respondents), recognized cover-up (24%), needed money (24%), recognized that their child would have no future (23%), needed information (20%), and decided to seek revenge or protect others from harm (19%). Over one third of all families indicated that they were told by medical personnel prior to filing that the care provided had caused their children's injuries. Families expressed dissatisfaction with physician-patient communication. Families believed that physicians would not listen (13% of sample), would not talk openly (32%), attempted to mislead them (48%), or did not warn about long-term neurodevelopmental problems (70%).
Families give many reasons for filing a claim. Obtaining money may not be the only goal for some families who file suit.
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"The nurses and other members of the healthcare team are no exception, regardless of the skill level, commitment or how careful they maybe (Hashemi 2012). Human errors are inevitable in any profession, and it is impossible to eliminate these errors completely (Hickson et al. 1999; Joolaee et al. 2011). The medication error complications were another category of the cultural organizational approach. "
[Show abstract][Hide abstract] ABSTRACT: Medical errors are one of the major threats for patient safety in all countries. Medication errors are common medical mistakes that can lead to serious consequences and even death of patients.
The aim of this study was to explore nurses' perspectives of factors influencing medication errors.
This qualitative study based on content analysis included 20 nurses (n = 20) with at least 2 years of clinical experience working in a large teaching hospital. The nurses were selected using purposeful sampling. The data were collected using semi-structured interviews and analysed using deductive content analysis approach based on Reason's human error model. Rigor of the data was confirmed by external and member check.
Two themes were identified by the participants: (1) the individual approach including personal and psychological characteristics of nurses, patient medical history and physicians' orders errors; and (2) the cultural and organizational approach including workplace conditions, learning process, risk management strategies, nurses' pharmacological knowledge, inevitable nursing errors and medication error complications.
Concern about the potential consequences related to reporting of the medication errors was the major limitation of this study. Participants' concerns were handled by keeping their identity confidential and anonymous.
Results show the importance of planning comprehensive educational programmes and providing constructive feedback in a favourable learning climate.
Findings of this study can be beneficial to managers for nurturing a transparent organizational culture, whereby staff members freely discuss their errors in patient care and seek advice for problem solving.
Full-text · Article · Feb 2014 · International Nursing Review
"Mistakes are an inevitable part of medical practice, making medical negligence claims a common event . Patient dissatisfaction and doctors' interpersonal relations with their patients are among the main reasons for medical negligence claims –. "
[Show abstract][Hide abstract] ABSTRACT: To describe the daily work practice under the threat of defensive medicine among obstetricians and gynecologists.
A prospective cross-sectional survey of obstetricians and gynecologists working at tertiary medical centers in Israel.
Among the 117 obstetricians and gynecologists who participated in the survey, representing 10% of the obstetricians and gynecologists registered by the Israel Medical Association, 113 (97%) felt that their daily work practice is influenced by concern about being sued for medical negligence and not only by genuine medical considerations. As a result, 102 (87%) physicians are more likely to offer the cesarean section option, even in the absence of a clear medical indication, 70 (60%) follow court rulings concerning medical practices, and 85 (73%) physicians mentioned that discussions about medical negligence court rulings are included in their departments' meetings.
Defensive medicine is a well-embedded phenomenon affecting the medical decision process of obstetricians and gynecologists.
"Studdert, Mello, Gawande, Brennan, and Wang (2007) suggested that disclosure and apology strategies have limited potential to reduce claims. However, a study of Florida families of infants with birth injuries who made malpractice claims found that anger, communication problems, and perceived deception and lack of honesty were common, and motivation for filing claims included wanting to find out what happened, seeking revenge, wanting to ensure that others avoided similar harm, and needing to air grievances (Hickson et al., 1992; Sloan et al., 1993). A 15-year disclosure program within a Veterans Affairs Medical Center was associated with substantial improvement in liability payouts, in contrast with trends for other system facilities (Kraman & Hamm, 1999; Kraman, Cranfill, Gamm, & Woodard, 2002). "
[Show abstract][Hide abstract] ABSTRACT: The present liability system is not serving well childbearing women and newborns, maternity care clinicians, or maternity care payers. Examination of evidence about the impact of this system on maternity care led us to identify seven aims for a high-functioning liability system in this clinical context. Herein, we identify policy strategies that are most likely to meet these aims and contribute to needed improvements. A companion paper considers strategies that hold little promise.
We considered whether 25 strategies that have been used or proposed for improvement have met or could meet the seven aims. We used a best available evidence approach and drew on more recent empirical legal studies and health services research about maternity care and liability when available, and considered other studies when unavailable.
Ten strategies seem to have potential to improve liability matters in maternity care across multiple aims. The most promising strategy-implementing rigorous maternity care quality improvement (QI) programs-has led to better quality and outcomes of care, and impressive declines in liability claims, payouts, and premium levels.
A number of promising strategies warrant demonstration and evaluation at the level of states, health systems, or other appropriate entities. Rigorous QI programs have a growing track record of contributing to diverse aims of a high-functioning liability system and seem to be a win-win-win prevention strategy for childbearing families, maternity care providers, and payers. Effective strategies are also needed to assist families when women and newborns are injured.
Full-text · Article · Feb 2013 · Women s Health Issues