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Rick Iedema, The UTS Centre for Health Communication  - What Patients Want After Medical Error: Communication and Compensation issues arising from the Australian Open Disclosure Studies
 

Rick Iedema, The UTS Centre for Health Communication - What Patients Want After Medical Error: Communication and Compensation issues arising from the Australian Open Disclosure Studies

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Professor Rick Iedema, The UTS Centre for Health Communication delivered this presentation at the 2013 Obstetric Malpractice Conference. This is the only national conference for the prevention, ...

Professor Rick Iedema, The UTS Centre for Health Communication delivered this presentation at the 2013 Obstetric Malpractice Conference. This is the only national conference for the prevention, management and defence of obstetric negligence claims.

For more information, go to http://www.healthcareconferences.com.au/obstetric13

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    Rick Iedema, The UTS Centre for Health Communication  - What Patients Want After Medical Error: Communication and Compensation issues arising from the Australian Open Disclosure Studies Rick Iedema, The UTS Centre for Health Communication - What Patients Want After Medical Error: Communication and Compensation issues arising from the Australian Open Disclosure Studies Presentation Transcript

    • What Patients Want after Medical Error Rick Iedema Professor & Director Centre for Health Communication University of Technology, Sydney Australia IIR 5th Annual Obstetric Malpractice Conference 20-21 June 2013
    • History of disclosure in Australia • 2003 Australian Open Disclosure Standard • 2005-7 ACSQHC pilot involving 42 hospitals • 2007-8 UTS-CHC evaluation of the pilot • 2009-11 “100 patient stories project” • 2011-12 ACSQHC drafting “Open Disclosure Framework‟ • 2013 ACSQHC publication of “Open Disclosure Framework‟ • 2014 integration of OD Framework into National Q&S Standards
    • What do patients want following unexpected outcomes? The 100 patient stories project • Funded by the Australian Commission on Safety and Quality in Health Care (ACSQHC) • Aims: – analyse 100 patients’/relatives’ experiences of disclosure – develop ‘Indicators of Effective Open Disclosure’ – initiate national stakeholder consultation about the indicators – design 2 questionnaire survey tools (1 patient/family, 1 staff) • Final report presented to the ACSQHC in July 2010 • Data resource (including video clips from 20 interviews) prepared for ACSQHC in 2011
    • Australian Commission on Safety & Quality in Health Care. The Australian Open Disclosure Framework. Sydney: Australian Commission on Safety & Quality in Health Care, 2013.
    • Patients want to be able to talk about unexpected outcomes
    • Patients want to be able to talk about unexpected outcomes
    • A (vanishing) legal risk? • “… of the 3250 closed claims in the year covered, only 3% were finalised through a court decision. The other 97% were either abandoned or settled, in about equal measure”. • “Pretrial processes, case management, improvements in early collection of data, expert opinions and evidentiary statements all help to narrow the issues well before a final hearing. The chances of earlier settlement are increased.” • “Courts have a protective role, such as approving treatment for patients without capacity to make their own decisions.” Madden B. (2013) Vanishing trials. Medical Journal of Australia. (11 June 2013)
    • Fewer trials … less independent scrutiny of how cases are handled and settled?
    • Incident, harm, abandonment • Uncomplicated pregnancy; labour at term • Baby’s CGT tracings misread; significant heart decelerations and baby distress not picked up for 8 hours; insufficient oxygen during birth process; medical intervention ceased after 3 days; baby died 28 days later • Providers unwilling to disclose the cause of the baby’s deterioration; try to implicate parents in the problem; inadequately attentive to baby’s distress and medication needs during the 25 days it takes to die • Family’s request for coronial inquest turned down • State’s Complaints Commission concludes: ‘Professional standards were upheld’
    • Complaints Commission response
    • Making it worse … • “It was very guarded … they were all very guarded. And we subsequently – when I got the files and reviewed them, there’s notations in the files saying. “Be careful when you speak with this family. Make sure there’s two staff members present when you speak with this family”. Things like that.” [mother]
    • Inverse proportionality? Perceivedlegalrisk Preparedness to be open 0 = low 5 = high
    • Plaintiff’s advice • “William’s death certificate appears to contain several errors. Neither “neonatal encephalopathy” or “perinatal compromise”, are found within ICD-10. Additionally, the meaning of “perinatal compromise” is unclear and does not identify what the “compromise” was. • Firstly, ‘Neonatal encephalopathy’ is incorrect as the condition directly leading to death, as this was a secondary condition and followed the birth injury. • There was a delay in the delivery of William, after rupture of membranes, which lead to his asphyxia. Perinatal asphyxia (lack of oxygen to the brain during labour) is the most common cause of neonatal encephalopathy. The damage to the baby results in difficulty with initiating and maintaining respiration, depression of tone and reflexes, sub normal level of consciousness and seizures. These problems are incompatible with life.”
    • The 100 patient stories study: Attitudes towards litigation
    • Redressing harm – ‘We had to sue’ Interviewer: And tell me [name], was the thought of going down the litigation track, was it for the pain? P1 - “...Oh I had to move. I had to move from the country to Adelaide to be closer to a hospital because of it. I actually had to uproot my whole life... But you know, the funniest part about it was actually the doctor who told me to sue...They actually told me to sue.” [082 - 100PT_MS_200510082] P2 - “I mean this has necessitated us to now sell our residential home. So not only is he trying to get better and we‟ve now had to sell our house because we can‟t afford the mortgage. So it‟s got a terrible, terrible knock on effect.” [091 - 100PT_MN_270510091]
    • But many chose not to sue … • “And I jokingly said to them: “Oh you’ve given me tainted blood, who can I sue? You or the blood bank?” They said “madam why would you think of suing us?” I said “because I was a solicitor for 40 years dear. But don’t panic I won’t do it, I know how long it will take, I’ll probably be dead by then”. [070 - 100PT_MN_190510070] • “I had so many people that said you know you should’ve sued them you should have done this and that. And I said you know what, one I couldn’t go through with it because I just, after losing [name son] you can barely function.” [042 - 100PT_MN_220310042] • “We talked to a solicitor about it...So we got that and then we decided that, the solicitor said “look you’re going to go through a lot of anxiety” [057 - 100PT_Q_120510057] • “ And, I will be quite honest with you, if I had the money, I would have gone a lot further with this. But we did not have the money to be paying any legal costs.” [052 - 100PT_N_15041052]
    • NSW Clinical Excellence Commission. Review of the Implementation of the NSW Health Open Disclosure Policy arising from the 2009 NSW Ombudsman’s Report. Sydney: Clinical Excellence Commission, 2012, p. 33.
    • Disclosure ~ two overarching dimensions • Material restoration – negotiating resource obligations in light of the implications of the harm caused – What financial-practical support do service users need to cope with and recover from the harm? • Symbolic restoration - understanding health service users’ relational expectations – How do service users want service providers to respond and proceed? – What scenarios do service users invite providers to engage in?
    • Conclusion • “Just disclosure”* – Provider(s) will participate in the scenarios which harmed patients/relatives invite them to enact – Providers act accountably • they behave as ‘model litigants’; • they recognise the conflict of interest that is inherent in their role as disclosers providers; • they welcome assistance from clinically-legally trained outsiders to scrutinise disclosure communication & compensation / settlement scenarios. *Iedema, R., Piper, D., Allen, S., Beitat, K., & Hor, S. (under review 2013). Reframing accountability for what goes wrong in health care as “just disclosure”. Joint Commission Journal for Quality and Patient Safety.
    • References Iedema R et al (under review) Reframing Accountability for What Goes Wrong in Health Care as “Just Disclosure”. US Joint Commission Journal of Quality and Patient Safety. Iedema R, Allen S. (2012) Anatomy of an incident disclosure: On the importance of dialogue. US Joint Commission Journal of Quality and Patient Safety. 38(10):435-42 Iedema, R., S. Allen, et al. (2011). The ‘100 Patient Stories’ Project: Patients’ and family members’ views of how clinicians (should) enact Open Disclosure. British Medical Journal. Iedema, R, Allen, S, Britton, K, and Gallagher, T (2011) What do patients and relatives know about problems and failures in care? BMJ Qual Saf 12:198-205 Iedema, R. (2010). "Attitudes Toward Error Disclosure: The Need to Engage with Systems Thinking." The Joint Commission Journal on Quality and Patient Safety 36(3): 99-100. Iedema, R., C. Jorm, et al. (2009). "Practising Open Disclosure: Clinical Incident Communication and Systems Improvement." Sociology of Health & Illness 31(2 ): 262-277. Iedema, R., C. Jorm, et al. (2009). "A New Structure of Attention? Open Disclosure of adverse events to patients and families." Journal of Language & Social Psychology 28(2): 139-157. Iedema, R., I. Curtiss, et al. (2008). Open Disclosure. Windows on quality and safety in health care 2008. Sydney, Australian Commission on Safety and Quality in Health Care: 61-72. Iedema, R., R. Sorensen, et al. (2008). "Patients’ and family members’ experiences of Open Disclosure following adverse events." International Journal for Quality in Health Care 20(6): 421-432. Iedema, R., N. Mallock, et al. (2008). Final Report: Evaluation of the National Open Disclosure Pilot Program. Sydney, The Australian Commission on Safety and Quality in Health Care. Iedema, R., N. Mallock, et al. (2008). "The National Open Disclosure Pilot: Evaluation of a Policy Implementation Initiative." Medical Journal of Australia 188(2008): 397-400.