Evidence
Alert

Patients are often unsatisfied with the explanation they receive when something goes wrong

Patients have a legal right to know when something goes wrong with their care. But previous research has shown that they do not always get a satisfactory explanation.

Researchers in Leeds and Bradford explored the expectations and challenges faced by both patients and healthcare professionals in talking about clinical errors. They found patients and professionals have different attitudes. Patients want accountability, an apology and a commitment that the same mistake will not be made again. In most cases, they are not satisfied with how they were told about a clinical error.  

Healthcare professionals believe they have a moral duty to give patients a full explanation of what happened.  But they say a culture of blame in their organisation and fear of legal action can prevent them from doing so. They say they lack training on appropriate ways to tell patients that an error has been made.  

This review suggests that healthcare professionals need more training in how to have these discussions with patients, and what the legal implications may be. A culture of transparency in healthcare settings would encourage more open and effective discussion of errors. 

What’s the issue?

Healthcare professionals have a legal duty to be open and honest with patients when things go wrong with their care. It is important that errors are discussed appropriately. Openness is generally promoted in health services across the world, but research suggests that patients are not always told the full story.  

Researchers wanted to understand the expectations, barriers and challenges faced by both patients and healthcare professionals surrounding the adverse event disclosure process.  

What’s new?

Researchers at the University of Leeds and the Bradford Institute for Health Research included 15 studies in their review. The studies collected the views or experiences of patients, their family members, and healthcare professionals.  The researchers brought the comments together to analyse how patients were told that something had gone wrong with their care. 

Patients and family members said they needed information related to the error. They stressed the importance of sincere regret and they wanted a promise of improvement to ensure the same error would not be made again. Patients were often unsatisfied with the apology they received, or felt they were only told half the story.  

Healthcare professionals admitted they did not always provide all information about the error. Some said they had owned up to errors in the past without ever saying ‘I’m sorry’. Many said they would conceal an error when they believed that honesty would cause the patient unnecessary anxiety. 

Doctors described several barriers to open discussion.  These included working in a blame culture, a fear of litigation, inconsistent guidance and a lack of skills on how to discuss errors with patients. This review suggests that there is a gap between what is expected of professionals and what actually happens.

The research suggests that a transparent culture within healthcare organisations is vital for effective discussion of errors.  

Why is this important?

When something has gone wrong with care, a full explanation may help maintain trust between patients and professionals. 

What’s next?

The researchers suggest that doctors and other healthcare staff could be trained to look at the situation from the patient’s point of view.  This would help healthcare professionals to think more broadly, and provide information the patient would consider most important. 

The studies included in this review were from North America, Australia, Europe, and Korea.  Different countries have different laws about what patients should be told, and how. Any changes need to take this legal background into account so different countries will have to have different approaches.  

Only one of the studies in the review came from the UK. Further work is needed to understand the best way to tell patients in this country about clinical errors in their care. Consistent and transparent policies on how to talk about clinical errors need to be developed, promoted and enforced within organisations. Researchers should explore barriers to discussing medical mistakes such as the existence of a blame culture within the UK healthcare system.

Author Raabia Sattar is developing a training intervention to support healthcare professionals who have to disclose adverse events in UK maternity services. 

You may be interested to read

The full paper: Sattar R and others. The views and experiences of patients and health-care professionals on the disclosure of adverse events: A systematic review and qualitative meta-ethnographic synthesis.  Health Expectations 2020;00:1–13

Regulation 20: Duty of Candour (2015), Care Quality Commission guidance for care providers on the requirements for an open and transparent environment

Second Victim Support website, for healthcare providers who have been affected by a patient safety incident

Harrison R and others. Enacting open disclosure in the UK National Health Service: a qualitative exploration. J Eval Clin Pract. 2017;23:713‐718

Kim CW and others. Improving disclosure of medical error through educational program as a first step toward patient safety. BMC Med Educ. 2017; 17: 52

Conflict of interest

The authors declare no conflicts of interest. 

Funding

This research was funded by NIHR CLAHRC Yorkshire and Humber. 

Commentaries

Study author

It is important to understand the expectations, barriers and challenges faced by healthcare professionals and patients. This can help generate interventions for adverse event reporting that are effective and practical for both groups.

These findings were not surprising in light of the previous literature conducted within the area of adverse event disclosure. However, most of the studies were conducted in the USA, Australia and Canada, with only one focusing on healthcare professionals’ experiences of disclosure within the UK. Given the sparse qualitative literature, further research is needed.

Raabia Sattar, PhD student, University of Leeds and Bradford Institute for Health Research, UK

Researcher

The way in which harms relating to medical care are communicated impacts on public confidence and trust in the healthcare system in general. There are many approaches to doing this with varying levels of transparency. A training package for healthcare professionals would not be difficult to develop, but many competing factors would need to be negotiated, such as what can and cannot be said.

At a more general level there is a question about how organisations can be more open and transparent. There is also a need to consider a different perspective. It is not just how best to engage with patients and their family members but also how to discuss the topic with healthcare professionals, given the pressure they are under.

Chris Vincent, Research Associate, UCL