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SA doctors want an ‘open disclosure’ culture over medical mistakes

The overwhelming majority of South African doctors (92%) believe healthcare workers must be in an environment where they can admit errors, apologise and learn from mistakes without fear of personal recrimination, if patient safety is to be continuously improved.

This is according to a survey of 590 doctors, carried out by the medical risk insurer, Medical Protection Society (MPS), which has more than 30,000 healthcare professionals as members in South Africa.

MPS said the survey results bring into sharp focus the need for the government and healthcare leaders to aid a shift to a more open, learning culture in healthcare, where healthcare professionals are supported to discuss and learn from mistakes, and patients are subsequently better protected and better informed in the future.

The organisation said that fear of blame, regulatory action or even criminal charges after an adverse incident are currently barriers to open disclosure, which must be broken down.

Dr Graham Howarth, Head of Medical Services – Africa said: “Doctors want to do their very best for patients, but medicine is not an exact science. Day in and day out doctors make complex decisions, often in fast moving or pressured circumstances. This means complications and errors can sometimes arise.

“If an error does occur, the practise of open disclosure should mean that the patient or their family is told, usually by the treating clinician, and receives a sincere apology and full explanation. This process also enables lessons to be learned to avoid a reoccurrence. Additionally, patients are better informed about their care.

“However, a culture of fear and blame across the South African healthcare community is currently a barrier to open disclosure and to a more open, learning environment being embraced. If we are to make continuous improvements to patient safety, it is a barrier that simply must be broken down.

“These survey results show the real strength of feeling on this issue from healthcare professionals.

“MPS plays a role in helping to create a more open, learning culture in healthcare. Our risk prevention programme equips members with a range of resources and training to combat the common causes of complaints and claims, including through improved communication. MPS also advises members that they should be open and honest with patients, that it is often appropriate to communicate regret and empathy following an adverse outcome, and that doing so is not necessarily an admission of liability.

“MPS is calling on healthcare leaders, hospitals, the government and individual clinicians to take active steps to further aid a shift to a culture of openness and learning, in which healthcare professionals feel able to apologise, discuss and learn from mistakes without fear of personal recrimination.

“This would ultimately help to prevent errors from reoccurring, improve patient safety in the future, and the increase in transparency may even help to reduce the number of claims and complaints brought against healthcare professionals when something goes wrong.”

The survey was conducted by MPS in mid-2021 and achieved 590 responses from medical practitioners and trainees in South Africa. Respondents were asked to what extent they agreed with the statement ‘If we are to continually improve patient care, all healthcare workers need to be in an environment where they feel confident to admit errors, apologise and learn from mistakes without fear of blame.’

The majority of respondents – 77% – strongly agreed with the statement, with 15% saying they somewhat agree, 2% neither agreeing nor disagreeing, 1% somewhat disagreeing and 6% stating they strongly disagree.

 

 

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