title: Improving reconciliation following medical injury: a qualitative study of responses to patient safety incidents in New Zealand.
abstract: BACKGROUND
  Despite the investment in exploring patient-centred alternatives to medical malpractice in New Zealand (NZ), the UK and the USA, patients' experiences with these processes are not well understood. We sought to explore factors that facilitate and impede reconciliation following patient safety incidents and identify recommendations for strengthening institution-led alternatives to malpractice litigation.
  
  
  METHODS
  We conducted semistructured interviews with 62 patients injured by healthcare in NZ, administrators of 12 public hospitals, 5 lawyers specialising in Accident Compensation Corporation (ACC) claims and 3 ACC staff. NZ was chosen as the research site because it has replaced medical malpractice litigation with a no-fault scheme. Thematic analysis was used to identify key themes from interview transcripts.
  
  
  RESULTS
  Interview responses converged on five elements of the reconciliation process that were important: (1) ask, rather than assume, what patients and families need from the process and recognise that, for many patients, being heard is important and should occur early in the reconciliation process; (2) support timely, sincere, culturally appropriate and meaningful apologies, avoiding forced or tokenistic quasi-apologies; (3) choose words that promote reconciliation; (4) include the people who patients want involved in the reconciliation discussion, including practitioners involved in the harm event; and (5) engage the support of lawyers and patient relations staff as appropriate.
  
  
  CONCLUSIONS
  Policymakers and healthcare institutions are keenly interested in non-litigation approaches to resolving malpractice incidents. Interviewing participants involved in patient safety incident reconciliation processes suggests that healthcare institutions should not view apology as a substitute for other remedial actions; use flexible guidelines that distil best-practice principles, ensuring that steps are not missed, while not prescribing a 'one size fits all' communication approach.
authors.affiliation: Faculty of Law, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Jennifer
authors.identifier: http://orcid.org/0000-0003-1300-7298
authors.initials: J
authors.lastname: Moore
authors.affiliation: Stanford Law School, Stanford University, Stanford, California, USA.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Mello
mesh_terms: D000328:Adult; D000368:Aged; D035881:Compensation and Redress; D005260:Female; D006740:Hospital Administrators / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D009520:New Zealand; D061214:Patient Safety / Q000331:legislation & jurisprudence*; D010361:Patients / Q000523:psychology*; D036301:Qualitative Research; D013997:Time Factors; D055815:Young Adult
keywords: Communication; Health policy; Never events; Patient safety; Qualitative research