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Assessing Patients’ Experiences with Medical Injury Reconciliation Processes


By Jennifer Schulz, LLB, PhD; Marie Bismark, LLB, MD, MPsych; Michelle Mello, JD, PhD; and Crispin Jenkinson, BA, MA, MSc, DPhil 

 It is well-known that injuries caused by health care can be traumatic for patients, families and health care providers. Patients and families may experience physical, psychological, emotional and financial harm. Health care providers may also feel traumatized.  

Key issues are: How can we best work towards “resolution” following medical injuries? How can we communicate with patients and families in ways that are sensitive and facilitate “resolution”?  

Many health care organizations have been using, or are considering the use of, alternative dispute resolution processes to better meet the needs of patients and families injured by harm events. This shift away from medical malpractice litigation has been occurring after reports from both patients and health care providers that litigation was: 

  • unsatisfactory 
  • stressful 
  • expensive 
  • failed to meet their needs following medical injury   

In our prior research,1 we studied the alternative dispute resolution processes for resolving medical injuries. We interviewed injured patients and health care providers in New Zealand and the United States to illuminate best practice recommendations so that organizations could better meet the needs of patients and families.  

Many health care providers told us that they would appreciate a tool that would allow them to test (efficiently and effectively) how well they met patients’ and families’ needs after medical injury. However, such a tool was not available.   

Tool to Assess Patient Needs After Medical Injury 
We embarked on a project to fill this gap and design a tool. The primary aim of our research, detailed in the June 2021 issue of The Joint Commission Journal on Quality and Patient Safety, was to generate items for a patient experience questionnaire that health care providers could use to assess how well they met patients’ needs following medical injuries.  

An important aspect of this project was the inclusion of injured patients and families in the questionnaire design. We conducted cognitive debriefing interviews with 24 injured patients in New Zealand and America. The feedback from these patients and families was used to revise and refine the questionnaire.  

All the patients and families who participated in this project commented that they were happy to do the interviews, and test the draft questionnaire, because it gave them an opportunity to discuss their experiences and help design a tool that might benefit other harmed and/or grieving patients and families. Their comments are contrary to the oft-heard fear that including injured patients and families in research will be the same as “poking the skunk”; in other words, a fear that asking injured patients and families about their experiences could result in undesirable outcomes such as litigation. Our earlier research called this fear into question.2 Our experiences of working with injured patients on the questionnaire project reinforced that the fear is unfounded.  

We hope that our latest research will highlight the importance and value of including patients’ voices in research and encourage institutional review boards and health care providers to conceptualize patients as partners, not adversaries.      

Jennifer Schulz, LLB, PhD, is Associate Professor, Faculty of Law, at the University of New South Wales in Sydney, Australia, and Affiliate Associate Professor, Bioethics Centre, University of Otago, New Zealand. Marie Bismark, LLB, MD, MPsych, is Associate Professor, Melbourne School of Population and Global Health, at the University of Melbourne, Australia. Michelle Mello, JD, PhD, is Professor of Law, Stanford Law School, and Professor of Medicine, Center for Health Policy/Primary Care and Outcomes Research, Department of Medicine, at Stanford University School of Medicine, California. Crispin Jenkinson, BA, MA, MSc, DPhil, is Professor of Health Services Research, and Director, Health Services Research Unit, Nuffield Department of Population Health, at the University of Oxford, England.