title: Professional liability insurance and medical error disclosure.
abstract: OBJECTIVE
  To examine medicolegal stakeholders' views about the impact of professional liability insurance in Switzerland on medical error disclosure.
  
  
  METHODS
  Purposive sample of 23 key medicolegal stakeholders in Switzerland from a range of fields between October 2012 and February 2013. Data were collected via individual, face-to-face interviews using a researcher-developed semi-structured interview guide. Interviews were transcribed and analysed using conventional content analysis.
  
  
  RESULTS
  Participants, particularly those with a legal or quality background, reported that concerns relating to professional liability insurance often inhibited communication with patients after a medical error. Healthcare providers were reported to be particularly concerned about losing their liability insurance cover for apologising to harmed patients. It was reported that the attempt to limit the exchange of information and communication could lead to a conflict with patient rights law. Participants reported that hospitals could, and in some case are, moving towards self-insurance approaches, which could increase flexibility regarding error communication
  
  
  CONCLUSIONS
  The reported current practice of at least some liability insurance companies in Switzerland of inhibiting communication with harmed patients after an error is concerning and requires further investigation. With a new ethic of transparency regarding medical errors now prevailing internationally, this approach is increasingly being perceived to be misguided. A move away from hospitals relying solely on liability insurance may allow greater transparency after errors. Legalisation preventing the loss of liability insurance coverage for apologising to harmed patients should also be considered.
authors.affiliation: Institute for Biomedical Ethics, University of Basel, Switzerland.
authors.forename: Stuart
authors.initials: S
authors.lastname: McLennan
authors.affiliation: Institute for Biomedical Ethics, University of Basel, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Shaw
authors.affiliation: Institute for Biomedical Ethics, University of Basel, Switzerland / Careum Research, Kalaidos University of Applied Sciences, Department Health, Zürich, Switzerland.
authors.forename: Agnes
authors.initials: A
authors.lastname: Leu
authors.affiliation: Institute for Biomedical Ethics, University of Basel, Switzerland.
authors.forename: Bernice
authors.initials: B
authors.lastname: Elger
mesh_terms: D003142:Communication; D006801:Humans; D007351:Insurance, Liability / Q000331:legislation & jurisprudence*; D019300:Medical Errors / Q000331:legislation & jurisprudence*; D028701:Patient Rights; D036301:Qualitative Research; D013557:Switzerland; D014342:Truth Disclosure