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. 2024 Dec 17:4:1473296.
doi: 10.3389/frhs.2024.1473296. eCollection 2024.

Humanising processes after harm part 2: compounded harm experienced by patients and their families after safety incidents

Lauren Ramsey  1 , Joanne Hughes  2 , Debra Hazeldine  2 , Sarah Seddon  2 , Mary Gould  2 , Jo Wailling  3 , Jenni Murray  1 , Siobhan McHugh  4 , Ruth Simms-Ellis  1   5 , Daisy Halligan  1 , Katherine Ludwin  6 , Jane K O'Hara  7
Affiliations

Humanising processes after harm part 2: compounded harm experienced by patients and their families after safety incidents

Lauren Ramsey et al. Front Health Serv. .

Abstract

Background: Healthcare organisations risk harming patients and their families twofold. First, through the physical, emotional and/or financial harm caused by safety incidents themselves, and second, through the organisational response to incidents. The former is well-researched and targeted by interventions. However, the latter, termed 'compounded harm' is rarely acknowledged.

Aims: We aimed to explore the ways compounded harm is experienced by patients and their families as a result of organisational responses to safety incidents and propose how this may be reduced in practice.

Methods: We used framework analysis to qualitatively explore data derived from interviews with 42 people with lived or professional experience of safety incident responses. This comprised 18 patients/relatives, 16 investigators, seven healthcare staff and one legal staff. People with lived and professional experience also helped to shape the design, conduct and findings of this study.

Findings: We identified six ways that patients and their families experienced compounded harm because of incident responses. These were feeling: (1) powerless, (2) inconsequential, (3) manipulated, (4) abandoned, (5) de-humanised and (6) disoriented.

Discussion: It is imperative to reduce compounded harm experienced by patients and families. We propose three recommendations for policy and practice: (1) the healthcare system to recognise and address epistemic injustice and equitably support people to be equal partners throughout investigations and subsequent learning to reduce the likelihood of patients and families feeling powerless and inconsequential; (2) honest and transparent regulatory and organisational cultures to be fostered and enacted to reduce the likelihood of patients and families feeling manipulated; and (3) the healthcare system to reorient towards providing restorative responses to harm which are human centred, relational and underpinned by dignity, safety and voluntariness to reduce the likelihood of patients and families feeling abandoned, de-humanised and disoriented.

Keywords: compounded harm; healthcare harm; healthcare litigation; patient involvement; patient safety; qualitative research; safety investigations.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Six types of compounded harm experienced by patients and families and the underlying need.
See this image and copyright information in PMC

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