Table 5 Summary of findings from 17 studies included for Question 2 across eight outcomes and seven types of intervention
Type of intervention | Definition | Total | ↓Claims | ↓ Complaints | ↓ Claims costs, or premiums | More timely management | ↓ Doctor risk profile/ ↑ performance | ↑ Staff confidence/knowledge | ↑ Culture | ↑ Patient satisfaction |
|---|---|---|---|---|---|---|---|---|---|---|
Risk management program | “a formal approach encompassing evaluation of complaints, improved communication in relation to complaints, and more direct use of insights gained from complaints analysis” [42] | 6 | ~ [31] | ✓ [42] | ✓[42] | – | ✓[40] | – | ||
Communication and resolution program | CRPs aim to better communicate adverse events to patients, investigate and explain what happened; provide emotional support; and apologise and proactively offer compensation if appropriate [35]. CRPs involve communication between doctor and patient outside the court setting to reach a mutual agreement to resolve the dispute and fair compensation and include apology laws in which apologies made by medical practitioners cannot be used as evidence in medical malpractice litigation [31] | 5 | ~ [13] | ✓ [33] | ~ [13] | ~ [13] | – | – | – | ✓ [33] |
Medical remediation | The process by which a doctor’s poor performance is ‘remedied’, which permits the doctor to return to safe practice [45]. It is formally defined as ‘an intervention, or suite of interventions, required in response to assessment against threshold standards’, with thresholds set by regulatory bodies (e.g. AHPRA in Australia) to keep patients safe [46] | 3 | ✓ [12] | – | – | – | – | – | – | |
Peer program | An organised effort whereby people (peers) critically appraise, systematically assess, monitor, make judgements, determine their strengths and weaknesses and review the quality of their practice, to provide evidence to use as the basis of recommendations by obtaining the opinion of their peers” [47, 48]. The use of peer messengers (doctors) involves the provision of feedback to doctors deemed at higher risk of experiencing a patient complaint or malpractice claim | 2 | – | ✓ [36] | – | – | ✓ [37] | – | – | – |
Shared decision-making | “Involving a patient and health care provider who work together to deliberate about the harms and benefits of two or more reasonable options, in order to choose a course of care that is ideally aligned with the patient’s preferences” (p. 2) [44] | 1 | ~ [44] | – | – | – | – | – | – | – |
Simulation training | “A technique for practice and learning that can be applied to many different disciplines and types of trainees. It is a technique (not a technology) to replace and amplify real experiences with guided ones, often ‘immersive’ in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion” (p. 349) [49] | 1 | ✓ [39] | – | ~ [39] | – | – | – | – | – |
Continuing professional development | A range of activities undertaken to maintain clinical skills and knowledge, as well as competence in the delivery of patient-centred care [50]. Participation in CPD is mandatory for doctors in several countries, including Australia and Canada, while being used to evaluate maintenance of competence in the USA | 1 | – | ✓ [41] | – | – | – | – | – | – |