Fear Of Litigation Research Articles

Corporate sustainability and biodiversity reporting: A proactive business strategy to mitigate litigation and reputational risks

AbstractBiodiversity is important to human's future survival and global sustainability. One way to achieve corporate sustainability is for firms to report its impacts on biodiversity. However, fear of litigation arising from reporting potentially deters corporations to disclose such information. Motivated by the importance of biodiversity and mixed evidence of shareholder litigation rights as a corporate governance tool, we explore whether the universal demand laws (UDLs) have any effect on corporate biodiversity reporting in the United States. Supporting our short‐termism, risk aversion and agency hypotheses, we find that an exogenous decline in the threat of derivative litigation, reducing a chance for shareholders to file a lawsuit against top management and intensifying agency costs, economically and significantly decreases a corporate's biodiversity reporting by 87%. When the disciplining effect of shareholder litigation drops, the self‐interest manager may want to live a quiet life and disclose less information of biodiversity impact. A proactive business strategy to mitigate litigation and reputational risks is to voluntarily disclose more biodiversity‐related information. Regulators around the world should also promote rigorous reporting requirements to reverse biodiversity loss and save our humanity.

Who Do We Serve? Role Conflict in Ontario Midwifery

The integration of midwifery into the Ontario health care system has posed challenges to the role of the midwife. The pressure to maintain hospital privileges and the fear of litigation can place midwives in opposition to their role of advocate and support for childbearning women. Additionally, collaborative maternity care models may also create conflicting demands on midwives. Midwives can experience these challenges as role conflict which can have a detrimental effect on midwifery care and lead to work stress and attrition in the profession. Open dialogue, further research, education, consumer involvement and improved interdisciplinary communication are among the strategies that could be used to better understand and address role conflict amongst midwives.

Perceived factors and barriers affecting physiotherapists’ decision to use spinal manipulation and mobilisation among infants, children, and adolescents: an international survey

ABSTRACT Objective To identify factors and barriers, which affect the utilisation of spinal manipulation and mobilisation among infants, children, and adolescents. Methods Twenty-six international expert physiotherapists in manual therapy and paediatrics were invited to participate in a Delphi investigation using QualtricsⓇ. In Round-1 physiotherapists selected from a list of factors and barriers affecting their decision to use spinal manipulation and mobilisation in the paediatric population and had opportunity to add to the list. Round-2 asked respondents to select as many factors and barriers that they agreed with, resulting in a frequency count. The subset of responses to questions around barriers and facilitators are the focus of this study. Results Twelve physiotherapists completed both rounds of the survey. Medical diagnosis, mechanism of injury, patient presentation, tolerance to handling, and therapist’s knowledge of techniques were the dominant deciding factors to use spinal manipulation and mobilisation among infants, children, and adolescents across spinal levels. More than 90% of the respondents selected manipulation as inappropriate among infants as their top barrier. Additional dominant barriers to using spinal manipulation among infants and children identified by ≥ 75% of the respondents included fear of injuring the patient, fear of litigation, lack of communication, lack of evidence, lack of guardian consent, and precision of the examination to inform clinical reasoning. Conclusion This international survey provides much needed insight regarding the factors and barriers physiotherapists should consider when contemplating the utilisation of spinal mobilisation and manipulation in the paediatric population.

Changes in the Cesarean Section Rate Following the Implementation of Guidelines Concerning Cesarean Section on Maternal Request

Traditionally, cesarean delivery on maternal request (CDMR) has been defined as a cesarean section performed at the request of the pregnant woman rather than for medical necessity. It was thought to provide minimal benefits to both the pregnant woman and the fetus and was seen as an inefficient use of healthcare resources. However, the recent rise in the choice and use of cesarean sections is influenced not only by obstetrical factors but also by psychological and socio-cultural factors of the mother, the desire among medical providers to avoid uncertainty, and the pursuit of time and economic convenience, among other complex factors. In particular, there is a growing trend among medical professionals who prefer cesarean sections to avoid costly medical lawsuits. However, if a pregnant woman opts for an elective cesarean section due to the convenience of medical professionals or fear of litigation, even if she prefers a vaginal delivery, it would be considered an unnecessary cesarean section. When a pregnant woman desires CDMR, medical professionals should thoroughly explain the advantages and disadvantages of both attempting vaginal delivery and CDMR so that she can make an informed decision. Nevertheless, if a pregnant woman still chooses a cesarean section after being fully informed, her autonomy should be respected. In such cases, it is recommended that medical practitioners use a minimally invasive surgical method, along with appropriate preoperative and postoperative care, to reduce the morbidity of both the mother and infant and to support a rapid recovery.

Safety incident reporting and barriers (SIRaB) study: Strategies and approaches for investigating patient safety events in a hospital set-up.

Unsafe patient events not only entail a clinical impact but also lead to economic burden in terms of prolonged hospitalization or unintended harm and delay in care delivery. Monitoring and time-bound investigation of patient safety events (PSEs) is of paramount importance in a healthcare set-up. To explore the safety incident reporting behaviour and the barriers in a hospital set-up. The study had two sections: (a) Retrospective assessment of all safety incidents in the past 1 year, and (b) Understanding the barriers of safety reporting by interviewing the major stakeholders in patient safety reporting framework. Further root cause analysis and failure mode effect analysis were performed for the situation observed. Results were statistically analyzed. Of the total of 106 PSEs reported voluntarily to the system, the highest reporting functional group was that of nurses (40.57%), followed by physicians (18.87%) and pharmacists (17.92%). Among the various factors identified as barriers in safety incident reporting, fear of litigation was the most observed component. The most commonly observed event was those pertaining to medication management, followed by diagnostic delay. Glitches in healthcare delivery accounted for 8.73% of the total reported PSEs, followed by 5.72% of events occurring due to inter-stakeholder communication errors. 4.22% of the PSEs were attributed to organizational managerial dysfunctionalities. Majority of medication-related PSE has moderate risk prioritization gradation. Effective training and sensitization regarding the need to report the patient unsafe incidents or near misses to the healthcare system can help avert many untoward experiences. The notion of 'No Blame No Shame' should be well inculcated within the minds of each hospital unit such that even if an error occurs, its prompt reporting does not get harmed.

Introduction to ethics in ethnography: The practical politics of predictability

This introduction to the ‘Ethics in ethnography’ special issue analyzes a crisis facing anthropology and especially ethnography, its primary research method. It highlights how an outdated and parochial ethics model, strengthened by fears of litigation and simplistic views of ethnographic research, threatens the spontaneity and investigative freedom necessary to the method's exploratory character. Contributors to the discussion explore the spectrum of strategies – from compromise to confrontation – for addressing the challenges posed by the bureaucratic oversight of ethics, unrealistic expectations of predictability in fieldwork, the impact of legitimate post‐colonial critique and funding constraints on research freedom. They variously address the arbitrariness of bureaucratic procedures and the potential stifling of anthropological enquiry under the guise of ethical oversight. Drawing on the range of experience in anthropology and related fields represented here, the introduction opens the collection with a call to maintain ethical sensitivity while challenging attempts to police fieldwork using inappropriate conceptions of science and ethics.

Disclosure following a medical error: lessons learned from a national initiative of workshops with patients, healthcare teams, and executives

BackgroundDespite the increase in disclosures of medical errors, transparency remains a challenge. Recognized barriers include shame, fear of litigation, disciplinary actions, and loss of patient trust. In 2018, the Israeli Ministry of Health initiated a series of workshops about disclosure of medical errors. The workshops involved medical center executives, healthcare providers, patients, and family members of patients who had previously been harmed by a medical error. This study presents the lessons learned about perceived challenges in disclosure of errors in 15 such workshops.MethodsData collection included participant observations in 15 workshops, full audio recordings of all of the workshops, and documentation of detailed field notes. Analysis was performed under thematic analysis guidelines.ResultsWe identified four main themes: “Providers agree on the value of disclosure of a medical error to the patient”; “Emotional challenges of disclosure of medical error to patients”; “The medico-legal discourse challenges transparency”; and “Providers and patients call for a change in the culture regarding disclosure of medical errors”. Participant observations indicated that the presence of a patient who had experienced a tragedy in another hospital, and who was willing to share it created an intimate atmosphere that enabled an open conversation between parties.ConclusionThe study shows the moral, human, and educational values of open discourse in a protective setting after the occurrence of a medical error. We believe that workshops like these may help foster a culture of institutional disclosure following medical errors. We recommend that the Ministry of Health extend such workshops to all healthcare facilities, establish guidelines and mandate training for skills in disclosure for all providers.

Opinions of UK General Dental Practitioners on the Restoration of Posterior Root Filled Teeth: a Vignette Survey.

To investigate factors which influence UK general dental practitioners (GDPs) when restoring posterior root filled teeth. An electronic survey was designed to explore current strategies of treatment of posterior root filled teeth by UK-based GDPs working in primary care. Three vignette cases included in the questionnaire explored a variety of tooth, patient, and financial factors. The survey was distributed by email and social media platforms between December 2018 and February 2019. A total of 528 valid responses were collected. The majority of participants (84.1%) regularly restored posterior root filled teeth with an indirect restoration. Presence of persistent symptoms post root canal treatment (RCT) completion would impact the management of 85% of the surveyed respondents. Referral to a specialist, deferral of provision of the definitive restoration, and fear of litigation were reported by the GDPs as influencing factors. This survey highlights that decision making regarding restoration of root filled teeth is a multifactorial process. Tooth, patient, and financial factors were all shown to influence the restorative management of the posterior root filled teeth.

Analysis of integrated project delivery in the Irish Construction industry

The construction industry is complex and suffers from considerable challenges related to Project Delivery Systems (PDS) most notably cost overruns and delays. Integrated Project Delivery (IPD) has gained traction in recent years and is lauded to be an effective mechanism to overcome many of these challenges. However, implementing IPD in practice is not an easy endeavor, and there is a need to understand the motivation to adopt it as well as to understand the key challenges and critical success factors for its effective implementation. This exploratory study aims to address this deficit. We capture real-world data from professionals in the Irish construction industry to understand current practices and analyze the perceived challenges and critical success factors for the successful implementation of IPD. Our findings reveal a significant lack of awareness among participants regarding IPD and very low levels of implementation. Issues such as lack of trust, fear of litigation and reluctance to change are the major barriers to implementation. Critical success factors for successful implementation center on establishing integrated systems such as BIM and ensuring that information, process knowledge and organizational teams are integrated.

Improving healthcare professionals' interactions with patients to tackle antimicrobial resistance: a systematic review of interventions, barriers, and facilitators.

Antimicrobial resistance (AMR) is a major public health threat. With the growing emphasis on patient-centred care/ shared decision making, it is important for healthcare professionals' (HCPs) who prescribe, dispense, administer and/or monitor antimicrobials to be adequately equipped to facilitate appropriate antimicrobial use. We systematically identified existing interventions which aim to improve HCPs interaction with patients and examined barriers and facilitators of appropriate the use of such interventions and appropriate antimicrobial use among both HCPs and patientsantimicrobial use while using these interventions. We searched MEDLINE, EMBASE, Web of Science, Google Scholar, and internet (via Google search engine). We included primary studies, published in English from 2010 to 2023 [PROSPERO (CRD42023395642)]. The protocol was preregistered with PROSPERO (CRD42023395642). We performed quality assessment using mixed methods appraisal tool. We applied narrative synthesis and used the COM-B (Capability, Opportunity, Motivation -Behaviour) as a theoretical framework for barriers and facilitators at HCP and patient levels. Of 9,172 citations retrieved from database searches, From 4,979 citations remained after removal of duplicates. We included 59 studies spanning over 13 countries. Interventions often involved multiple components beyond HCPs' interaction with patients. From 24 studies reporting barriers and facilitators, we identified issues relating to capability (such as, knowledge/understanding about AMR, diagnostic uncertainties, awareness of interventions and forgetfulness); opportunity (such as, time constraint and intervention accessibility) and motivation (such as, patient's desire for antibiotics and fear of litigation). The findings of this review should be considered by intervention designers/adopters and policy makers to improve utilisation and effectiveness.

The experience of drug-related client loss for healthcare professionals who support people in addiction

IntroductionAddiction support and recovery is a multi-faceted support context in which practitioners work with clients who present with increased mortality risks. Drug-related deaths are understood to be a risk factor for complicated grief-reactions but, to date, research has neglected to explore the intricacies of drug-related client loss for practitioners who work with clients experiencing addiction. Due to wider expectations of professional endurance and the demanding nature of health care, grief-related reactions associated with the loss of a client may go unprocessed and, therefore, result in long-term health implications. MethodFifteen health care professionals took part in individual semi-structured interviews, which were analyzed using reflexive thematic analysis. Participants represented various disciplines in addiction support and recovery, including homelessness, inclusion health, addiction, and emergency medicine. ResultsThree core themes emerged encapsulating the experience of drug-related bereavement for HCPs who support people experiencing addiction, as follows: (i) Grief Beneath the Surface, (ii) The Cost of Caring, and (iii) Finding Closure. The findings identified acute grief-related reactions in HCPs such as self-blame and shame, alongside fears of litigation and questions of clinical competency. Participants' accounts of drug-related client loss emphasized a deep professional connection with those that they work with, with grief-responses akin to the loss of peers, family members, and other close connections. The bereavement experience was complicated by unique compounding variables associated with drug-related deaths, but also by incongruity between their emotional responses to death and their professional responsibilities. ConclusionsThis article highlights the complex nature of drug-related client loss, and despite their social positioning as experts in their field, HCPs' reactions to client deaths were predominantly human responses to loss. The article identified a need for targeted postvention protocols that address complicated grief while also allowing staff to resume occupational functioning in a measured manner.

Prevalence and determinants of defensive medicine among physicians: a systematic review and meta-analysis

Abstract Defensive medicine, characterized by physicians’ inclination toward excessive diagnostic tests and procedures, has emerged as a significant concern in modern healthcare due to its high prevalence and detrimental effects. Despite the growing concerns among healthcare providers, policymakers, and physicians, comprehensive synthesis of the literature on the prevalence and determinants of defensive medicine among physicians has yet been reported. A comprehensive literature search was conducted to identify eligible studies published between 1 January 2000 and 31 December 2022, utilizing six databases (i.e. Web of Science, PubMed, Embase, Scopus, PsycINFO, and Cochrane Library). A meta-analysis was conducted to determine the prevalence and determinants of defensive medicine. Of the 8892 identified articles, 64 eligible studies involving 35.9 thousand physicians across 23 countries were included. The overall pooled prevalence of defense medications was 75.8%. Physicians engaged in both assurance and avoidance behaviors, with the most prevalent subitems being increasing follow-up and avoidance of high-complication treatment protocols. The prevalence of defensive medicine was higher in the African region [88.1%; 95% confidence interval (CI): 80.4%–95.8%] and lower-middle-income countries (89.0%; 95% CI: 78.2%–99.8%). Among the medical specialties, anesthesiologists (92.2%; 95% CI: 89.2%–95.3%) exhibited the highest prevalence. Further, the pooled odds ratios (ORs) of the nine factors at the individual, relational, and organizational levels were calculated, and the influence of previous experience in medical-legal litigation (OR: 1.65; 95% CI: 1.13–2.18) should be considered. The results of this study indicate a high global prevalence of defensive medicine among physicians, underscoring the necessity of implementing targeted interventions to reduce its use, especially in certain regions and specialties. Policymakers should implement measures to improve physicians’ medical skills, enhance physician–patient communication, address physicians’ medical-legal litigation fears, and reform the medical liability system. Future research should focus on devising and assessing interventions to reduce the use of defensive medicine and to improve the quality of patient care.

What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review

ObjectivesLow-value care can harm patients and healthcare systems. Despite a decade of global endeavours, low value care has persisted. Identification of barriers and enablers is essential for effective deimplementation of...

Improving healthcare professionals’ interactions with patients to tackle antimicrobial resistance

Abstract Background Antimicrobial resistance (AMR) is one of the most important public health threats. It is important for healthcare professionals (HCPs) who prescribe, dispense, administer and/or monitor antimicrobials to mitigate inappropriate antimicrobial use. This review identified existing interventions which aim to improve HCPs’ interaction with patients and examined factors that enables or hinders appropriate behaviours. Methods We searched MEDLINE, EMBASE, Science Citation Index, Social Sciences Citation Index, Google Scholar, internet and conducted forward and backward citation searching from eligible studies. We included studies of any design, published in English language from year 2010 to 2023. We applied narrative synthesis and used the COM-B (Capability, Opportunity, Motivation - Behaviour) as a theoretical framework for barriers and facilitators at HCP and patient levels. Results We included 59 studies of diverse designs examining a range of interventions from 16 countries. Many interventions involved multiple components beyond HCPs’ interaction with patients, e.g., Treat Antibiotics Responsibly, Guidance, Education and Tools (TARGET). Patient interaction components mostly involved use of posters, leaflets, videos, interactive decision support tools and C reactive protein point-of-care testing. The interventions were often found to be useful. Barriers and facilitators identified related to capability (e.g., knowledge/understanding about AMR, diagnostic uncertainties, awareness of interventions, forgetfulness); opportunity (e.g., time constraint, intervention accessibility) and motivation (e.g., patient's desire for antibiotics, fear of litigation). Conclusions There are many useful interventions to improve HCPs and patients’ interactions for appropriate behaviours in antibiotic use. The barriers and facilitators identified in this review should be considered by intervention designers/adopters and policy makers to improve implementation and effectiveness. Key messages • Factors hindering appropriate antimicrobial use are complex. • This review can inform the development and implementation of strategies to improve healthcare professional’ interaction with the users.

FIGO opinion paper: Drivers and solutions to the cesarean delivery epidemic with emphasis on the increasing rates in Africa and Southeastern Europe.

Cesarean delivery rates are rapidly increasing in Southeastern Europe (to more than 60%), North Africa (with a rate as high as 72% in Egypt), and in urban areas in Southern Africa (a rate of over 50% in Lagos, Nigeria). Data on the background to these increases are scarce, but likely to include poor birthing facilities in general hospitals, convenience for the doctor, private medicine, fear of litigation, socioeconomic status, shortage of midwives and nurses, and disappearance of vaginal instrumental deliveries. Options to reverse cesarean delivery trends are discussed. In this context there is a need to be better informed about how women are being counseled regarding vaginal or cesarean delivery. The long-term consequences in subsequent pregnancies for mothers and children may well be largely ignored, while these risks are highest in LMICs where higher birth numbers are desired. FIGO has begun discussions with obstetric and gynecologic societies, healthcare bodies, and governments in several countries discussed in this article, to find ways to lower the cesarean delivery rate. The requests came from the countries themselves, which may prove beneficial in helping advance progress.

Maternal Morbidity Following a Trial of Labor After Cesarean Section vs. Elective Repeat Cesarean Delivery at KIU Teaching Hospital

This study aimed to determine maternal morbidity and predictors of successful vaginal birth control (VBAC) among women at KIU Teaching Hospital. A retrospective cohort study was used, with 384 files of women who delivered between 2014 and 2018 selected. Descriptive statistics were used to determine the incidence of maternal morbidities. Univariate analysis and bivariate logistic regression were performed using STATA version 14.0 to identify predictors of successful VBAC. The mean age of the study participants was 25.62 years, with 63.54% of them elective repeat caesarean sections (ERCD) and 36.46% trial of labor after caesarean sections (TOLAC). Morbidities included uterine rupture, thromboembolism, transfusion requirement, and endometritis. Risks of TOLAC versus ERCD included uterine rupture, thromboembolism, and blood transfusion requirement. BMI, birth weight, spontaneous onset of labor, previous safe vaginal birth, and non-diabetic status were found to be predictors of successful VBAC. Delivering women with previous cesarean sections is a complex process that involves the physician's knowledge, experience, and fear of litigation, as well as the previous maternal experience and knowledge. Any decision made will affect the present pregnancy's outcome, future obstetric performance, and fertility of the patient. Keywords: Maternal Mortality Rate, Cesarean delivery, Women, pregnancy, Labour.

A Survey for Assessment of Practical Aspects of End-of-life Practices across Indian Intensive Care Units.

The end-of-life (EOL) decisions continue to be debated for their moral and legal standing. The acceptance of these decisions varies, based upon the perceptions and personal choices of the intensivists. An online questionnaire-based survey was designed and circulated among the practicing intensivists via Indian Society of Critical Care Medicine (ISCCM) e-mail. Out of 200 responses, 165 (82.5%) affirmed that EOL decisions are routinely undertaken in their intensive care units. The most prevalent reasons expressed for avoidance of EOL decisions are moral and ethical dilemmas and fear of litigation. There is notable variability in the practice of withholding (47.7%) vs withdrawal (3.5%) of therapies. A good proportion of intensivists follow do-not-intubate (91%) and do-not-resuscitate (86%) orders, whereas only 18% affirmed to be practicing terminal extubation. About 93% of the respondents acknowledged the use of monitoring toward the EOL, and 49% reported the use of preformatted documents. A meager 2% admitted to facing a medicolegal issue after taking an EOL decision. The survey establishes a general acceptance among the Indian intensivists regarding providing compassionate care to terminally ill patients, especially toward the EOL. The pattern of responses, however, indicates significant dilemmas and hesitancy with regard to the decision-making process. Kumar A, Sinha S, Mani RK. A Survey for Assessment of Practical Aspects of End-of-life Practices across Indian Intensive Care Units. Indian J Crit Care Med 2023;27(8):531-536.

A Focus on Contraception in the Wake of Dobbs.

A Focus on Contraception in the Wake of Dobbs.

Factors impacting on the decision of graduate entry medical school students to pursue a career in obstetrics and gynecology in Ireland

BackgroundChallenges in recruiting appropriately trained obstetricians and gynaecologists have been identified across the world. Given well documented staff shortages within obstetrics and gynaecology in Ireland, it is increasingly important to understand the factors which influence medical students to choose or reject a career in the speciality. The aim of this study was to ascertain the perceptions of final year graduate entry medical students of obstetrics and gynaecology, including the factors which may influence a student’s decision to pursue in a career in the speciality.MethodsPaper-based surveys of graduate entry medical students (n = 146) were conducted at the beginning and end of a six week rotation in obstetrics and gynaecology in Ireland. Responses to the surveys pre- and post-rotation were matched and changes in career choices, merits and demerits over time were analysed. All analysis was conducted using SPSS for Windows version 25.ResultsThe responses of 72 students to both questionnaires could be matched (response rate of 49.3%). No male students expressed an interest in obstetrics, gynaecology or both as a first choice of career in the pre rotation survey. Obstetrics as a first choice of career increased from 6.9% pre rotation to 19.4% post rotation (p = 0.04) and this increase was seen in male and female students. Gynaecology as a first choice increased slightly from 1.4 to 4.2% (p = 0.50) and the dual speciality increased from 6.9 to 13.9% (p = 0.23). Students identified many merits of obstetrics pre-rotation with more than 60% identifying it as exciting, interesting fulfilling and challenging. However, incompatibility with family life was cited as a demerit by 72% of respondents and 68.1% identified fear of litigation as a demerit. Participants were less positive overall about the merits of a career in gynaecology with less than 40% viewing it as exciting, fulfilling, and varied.ConclusionsWhile respondents were positive about the merits of a career in obstetrics and gynecology, concerns remain about work-life balance, career opportunities, and the high-risk nature of the specialty. These concerns should be addressed by the profession and policy makers if they wish to attract sufficient numbers to address anticipated need in the coming years. Gender differences in speciality choice were also evident. If males are to be recruited into obstetrics and gynaecology, consideration should be given to the positive impact of internship.

Contemporary Use of Computed Tomography (CT) Imaging in Suspected Urolithiasis in Pregnancy.

We aimed to examine the role of low-dose CT (LDCT) in the diagnostic work-up for suspected urolithiasis in pregnancy. We reviewed contemporary urologic recommendations for CT in pregnancy, its utilization for suspected urolithiasis, and explored barriers to its use. National urologic guidelines and the American College of Obstetricians and Gynecologists recommend the judicious use of LDCT imaging in pregnancy when necessary. We noted inconsistencies in review article management pathways and recommendations for CT imaging for suspected urolithiasis in pregnancy. Overall CT utilization in pregnancy for suspected urolithiasis is low. Proposed barriers to LDCT use in pregnancy include fears of litigation and misperceptions of the harm of diagnostic radiation. Recent advancements in imaging technologies for urolithiasis in pregnancy are limited. More specific diagnostic pathway recommendations from national urologic guideline bodies for when to use LDCT to investigate renal colic in pregnancy may reduce diagnostic and intervention delays.