International Journal for Quality in Health Care Advance Access originally published online on July 21, 2005
International Journal for Quality in Health Care 2005 17(6):479-486; doi:10.1093/intqhc/mzi065
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Patient perspectives of patient–provider communication after adverse events
1 JSI Research & Training Institute, 2 COPIC Insurance Company, and 3 Department of Family Medicine, University of Colorado at Denver and Health Sciences Center, Denver, CO, USA
Objective. To explore patient perceptions of patient–provider communication after an actual adverse medical event because prior patient error studies are rarely based on real situations.
Design. We conducted four patient focus groups using a semi-structured guide. We analyzed transcripts using an editing approach to identify themes.
Setting. Three sites in Colorado.
Study participants. Participants were recruited from statewide post-injury program. Purposeful sampling began with patients in a geographic location; we contacted every other patient (up to 50). Twenty-two patients initially agreed to participate; 16 adults participated, representing 13 cases.
Results. Complex issues and processes were involved in resolution attempts. Effective communication was an important factor in whether professional relationships continued after an adverse event. The communication nature and quality influenced whether patients defined event as ‘honest mistake’ or ‘error’. Two types of trauma (physical and emotional) were expected and found. A third (financial) uncovered and proved in some cases the most salient factor influencing patients’ subsequent actions. Caring, honest, quick, personal, and repeated provider responses were linked to patient satisfaction.
Conclusions. Provider communication timeliness and quality were important influences on patients’ responses to adverse events. Confronting an adverse medical event collaboratively helped both patients and providers with patients’ emotional, physical, and financial trauma and minimized the anger and frustration commonly experienced. Health organizations, providers, investigators, and policymakers should consider the patient experience when developing provider training or evaluating processes in patient resolution.
Keywords: medical errors, patient perspective, patient–provider communication, qualitative research
Address reprint requests to Christine W. Duclos, 2311 Alton St., Denver, Co 80238. E-mail: cduclos{at}jsi.com/christineduclos{at}comcast.net
Accepted for publication June 18, 2005.
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