Abstract
To examine medicolegal stakeholders' views about the impact of professional liability insurance in Switzerland on medical error disclosure. 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. 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 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.
Highlights
Despite clinicians being widely considered internationally to have an ethical, professional and legal obligation to disclose medical errors to patients [1,2,3,4], there remains a large “disclosure gap” between expected practice and what is being done [5]
Interviews were transcribed and analysed using conventional content analysis. Participants, those with a legal or quality background, reported that concerns relating to professional liability insurance often inhibited communication with patients after a medical error
Participants reported that hospitals could, and in some case are, moving towards self-insurance approaches, which could increase flexibility regarding error communication CONCLUSION: 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
Summary
Despite clinicians being widely considered internationally to have an ethical, professional and legal obligation to disclose medical errors to patients [1,2,3,4], there remains a large “disclosure gap” between expected practice and what is being done [5]. Every hospital is obligated to cover their third-party liability risk in the appropriate form, independently from their legal structure – whether they are run by the Canton, the municipality or by a private company, and whether they receive subsidies (see § 36 Abs. 2 in connection with § 12 Abs. 2 general health law for the canton Zurich [GesG, LS 810.1]). It is the hospital’s responsibility to cover this risk, whether they guarantee the coverage through liability insurance, by creating accruals or through a combination of accruals and liability insurance. As a part of a broader study into medical error communication in Switzerland, key medicolegal stakeholders were interviewed to explore their general attitudes towards med-
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