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Third Things as Inspiration and Artifact: A Multi-Stakeholder Qualitative Approach to Understand Patient and Family Emotions after Harmful Events

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Abstract

Patient and family emotional harm after medical errors may be profound. At an Agency for Healthcare Research and Quality (AHRQ) conference to establish a research agenda on this topic, the authors used visual images as a gateway to personal reflections among diverse stakeholders. Themes identified included chaos and turmoil, profound isolation, organizational denial, moral injury and betrayal, negative effects on families and communities, importance of relational skills, and healing effects of human connection. The exercise invited storytelling, enabled psychological safety, and fostered further collaborative discussion. The authors discuss implications for quality/safety, educational innovation, and qualitative research.

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References

  • Batalden, M., P. Batalden, P. Margolis, M. Seid, G. Armstrong, L. Opipari-Arrigan, and H. Hartung. 2016. "Coproduction of Healthcare Service." BMJ Qual Saf 25 (7): 509-517.

    Article  Google Scholar 

  • Beaty, R. E., P. J. Silvia, and M. Benedek. 2017. "Brain Networks Underlying Novel Metaphor Production." Brain Cogn 111: 163-170.

    Article  Google Scholar 

  • Bell, S. K., J. M. Etchegaray, E. Gaufberg, E. Lowe, M. J. Ottosen, K. E. Sands, B. S. Lee, E. J. Thomas, M. Van Niel, L. Kenney, and Group Healing After Harm Conference. 2018. "A Multi-Stakeholder Consensus-Driven Research Agenda for Better Understanding and Supporting the Emotional Impact of Harmful events on Patients and Families." Jt Comm J Qual Patient Saf 44 (7): 424-435.

    Google Scholar 

  • Center for Creative Leadership. 2017. Visual Explorer Facilitator's Guide. CCL Press: Greensboro, NC.

  • Cooperrider, D. L. , and S. Srivastva. 1987. "Appreciative Inquiry in Organizational Life." In Research in Organizational Change And Development, edited by R. W. Woodman and W.A. Pasmore. 129–169. Stamford, CT: JAI Press.

    Google Scholar 

  • Corbin, J. , and A. Strauss. 2008. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 3rd ed. Thousand Oaks: Sage.

    Book  Google Scholar 

  • Delbanco, T., and S. K. Bell. 2007. "Guilty, Afraid, and Alone--Struggling with Medical Error." N Engl J Med 357 (17): 1682-1683.

    Article  Google Scholar 

  • Donaldson, L. J. 2015. "The Wisdom of Patients and Families: Ignore it at our Peril." BMJ Qual Saf 24 (10): 603-604.

    Article  Google Scholar 

  • Franklin, R.W. , ed. 2005. The Poems of Emily Dickinson: Reading Edition. Cambridge: Belknap Press of Harvard University Press.

    Google Scholar 

  • Gallagher, T. H., A. D. Waterman, A. G. Ebers, V. J. Fraser, and W. Levinson. 2003. "Patients' and Physicians' Attitudes Regarding the Disclosure of Medical Errors." JAMA 289 (8): 1001-1007.

    Article  Google Scholar 

  • Gaufberg, Elizabeth, and Maren Batalden. 2007. "The Third Thing in Medical Education." Clinical Teacher 4:78-81.

    Article  Google Scholar 

  • Gaufberg, Elizabeth, and Ray Williams. 2011. "Reflection in a Museum Setting: The Personal Responses Tour." J Grad Med Educ 3 (4): 546-549.

    Article  Google Scholar 

  • Haidet, P., J. Jarecke, N. E. Adams, H. L. Stuckey, M. J. Green, D. Shapiro, C. R. Teal, and D. R. Wolpaw. 2016. "A Guiding Framework to Maximise the Power of the Arts in Medical Education: A Systematic Review and Metasynthesis." Med Educ 50 (3): 320-331.

    Article  Google Scholar 

  • Haight, Wendy, Erin Sugrue, Molly Calhoun, and James Black. 2016. "A Scoping Study of Moral Injury: Identifying Directions for Social Work Research." Children and Youth Services Review 70 (Supplement C): 190-200.

    Article  Google Scholar 

  • Iedema, R., R. Sorensen, E. Manias, A. Tuckett, D. Piper, N. Mallock, A. Williams, and C. Jorm. 2008. "Patients' and Family Members' Experiences of Open Disclosure following Adverse Events." Int J Qual Health Care 20 (6): 421-432.

    Article  Google Scholar 

  • Iedema, R., S. Allen, K. Britton, D. Piper, A. Baker, C. Grbich, A. Allan, L. Jones, A. Tuckett, A. Williams, E. Manias, and T. H. Gallagher. 2011. "Patients' and family members' views on how clinicians enact and how they should enact incident disclosure: the '100 patient stories' qualitative study." BMJ 343: d4423.

  • Iezzoni, L. I., S. R. Rao, C. M. DesRoches, C. Vogeli, and E. G. Campbell. 2012. "Survey Shows that at Least some Physicians are not always Open or Honest with Patients." Health Aff (Millwood) 31 (2): 383-391.

    Article  Google Scholar 

  • Langer, T., W. Martinez, D. M. Browning, P. Varrin, B. Sarnoff Lee, and S. K. Bell. 2016. "Patients and Families as Teachers: A mixed Methods Assessment of a Collaborative Learning Model for Medical Error Disclosure and Prevention." BMJ Qual Saf 25 (8): 615-625.

    Article  Google Scholar 

  • Leape, L. L., D. M. Berwick, and D. W. Bates. 2002. "What Practices will most Improve Safety? Evidence-based Medicine meets Patient Safety." JAMA 288 (4): 501-507.

    Article  Google Scholar 

  • Leape, L. L., M. F. Shore, J. L. Dienstag, R. J. Mayer, S. Edgman-Levitan, G. S. Meyer, and G. B. Healy. 2012. "Perspective: A Culture of Respect, Part 1: The Nature and Causes of Disrespectful Behavior by Physicians." Acad Med 87 (7): 845-852.

    Article  Google Scholar 

  • Luff, D., E. B. Martin, Jr., K. Mills, N. M. Mazzola, S. K. Bell, and E. C. Meyer. 2016. "Clinicians' Strategies for Managing their Emotions during Difficult Healthcare Conversations." Patient Educ Couns 99 (9): 1461-1466.

    Article  Google Scholar 

  • Makary, M. A., and M. Daniel. 2016. "Medical Error--the Third Leading Cause of Death in the US." BMJ 353: i2139.

    Article  Google Scholar 

  • Maltby, J., L. Day, R. M. Hatcher, S. Tazzyman, H. D. Flowe, E. J. Palmer, C. A. Frosch, M. O'Reilly, C. Jones, C. Buckley, M. Knieps, and K. Cutts. 2016. "Implicit Theories of Online Trolling: Evidence that Attention-seeking Conceptions are Associated with Increased Psychological Resilience." Br J Psychol 107 (3): 448-466.

    Article  Google Scholar 

  • Mazor, K. M., S. L. Goff, K. S. Dodd, S. J. Velten, and K. E. Walsh. 2010. "Parents' Perceptions of Medical Errors." J Patient Saf 6 (2): 102-107.

    Article  Google Scholar 

  • Mazor, K. M., D. W. Roblin, S. M. Greene, C. A. Lemay, C. L. Firneno, J. Calvi, C. D. Prouty, K. Horner, and T. H. Gallagher. 2012. "Toward Patient-centered Cancer Care: Patient Perceptions of Problematic Events, Impact, and Response." J Clin Oncol 30 (15): 1784-1790.

    Article  Google Scholar 

  • Moore, J., M. Bismark, and M. M. Mello. 2017. "Patients' Experiences with Communication-and-Resolution Programs after Medical Injury." JAMA Intern Med 177 (11): 1595-1603.

    Article  Google Scholar 

  • Moore, J., and M. M. Mello. 2017. "Improving Reconciliation following Medical Injury: A Qualitative Study of Responses to Patient Safety Incidents in New Zealand." BMJ Qual Saf 26: 788-798.

    Article  Google Scholar 

  • Nash, W. P., T. L. Marino Carper, M. A. Mills, T. Au, A. Goldsmith, and B. T. Litz. 2013. "Psychometric Evaluation of the Moral Injury Events Scale." Mil Med 178 (6): 646-652.

    Article  Google Scholar 

  • Ottosen, M., E. Sedlock; A. Aigbe; S. Bell; T. Gallagher. 2018. "Longterm Impacts Faced by Patients and Families after Harmful Healthcare Events." J Patient Safety. Jan 17 [Epub ahead of print]. https://doi.org/10.1097/PTS.0000000000000451.

  • Palmer, P.J. 2009. A Hidden Wholeness: The Journey toward an Undivided Life. San Francisco, CA: Jossey-Bass.

    Google Scholar 

  • Palus, C.J., and D.M. Horth. 2002. The Leader's Edge: Six Creative Competencies for Navigating Complex Challenges. Hoboken: John Wiley & Sons.

    Google Scholar 

  • Palus, CJ, and JB McGuire. 2015. "Mediated Dialogue in Action Research." In The SAGE Handbook of Action Research, edited by Hilary Bradbury. 691-699. Thousand Oaks California: SAGE.

    Chapter  Google Scholar 

  • Peterkin, Allan, and Pamela Brett-MacLean. 2016. Keeping Reflection Fresh: A Practical Guide for Clinical Educators. Kent, OH: Kent State University Press.

    Google Scholar 

  • Plews-Ogan, M., N. May, J. Owens, M. Ardelt, J. Shapiro, and S. K. Bell. 2016. "Wisdom in Medicine: What Helps Physicians after a Medical Error?" Acad Med 91 (2): 233-241.

    Article  Google Scholar 

  • Schwartz, D. 1989. "Visual Ethnography: Using Photography in Qualitative Research." Qualitative Sociology 12 (2): 119-154.

    Article  Google Scholar 

  • Selvin, A., S. Buckingham Shum, M. Seirhuis, J. Conklin, B. Zimmerman, C. Palus, W. Drath, D. Horth, J. Domingue, E. Motta, and G. Li. 2001. "Compendium: Making Meetings into Knowledge Events." In Knowledge Technologies 2001, 4-7 March, Texas, USA.

  • Southwick, F. S., N. M. Cranley, and J. A. Hallisy. 2015. "A Patient-initiated Voluntary Online Survey of Adverse Medical Events: The Perspective of 696 Injured Patients and Families." BMJ Qual Saf 24 (10): 620-629.

    Article  Google Scholar 

  • Tang, P. C., and M. D. Smith. 2016. "Democratization of Health Care." JAMA 316 (16): 1663-1664.

    Article  Google Scholar 

  • Vincent, C. A., and A. Coulter. 2002. "Patient Safety: What about the Patient?" Qual Saf Health Care 11 (1): 76-80.

    Article  Google Scholar 

  • Watling, C. J., and L. Lingard. 2012. "Grounded Theory in Medical Education Research: AMEE Guide No. 70." Med Teach 34 (10): 850-861.

    Article  Google Scholar 

  • Welch, Jonathan R. 2012. "As She Lay Dying: How I Fought to Stop Medical Errors from Killing My Mom." Health Affairs 31 (12): 2817-2820.

    Article  Google Scholar 

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Acknowledgements

The authors acknowledge Brandy King, Ellen Hedstrom, and Melinda Van Niel for their help organizing the exercise and conference, and with manuscript preparation. They acknowledge the Healing after Harm Conference Group for their active participation in the exercise: Irim Azam, Susan Baade Song, Sigall K. Bell, Marie Bismark, Rick Boothman, Ilene Corina, Jeff Driver, Jason Etchegaray, Barbara Fain, Patricia Folcarelli, Dominick Frosch, Thomas Gallagher, Tejal Gandhi, Lynne Garner, Elizabeth Gaufberg, Tara Gibson, Erin Grace, Paula Griswold, Helen Haskell, Rick Iedema, Paul Karner, Linda Kenney, Carol Keohane, Susan LaFarge, Tanya Lord, Elizabeth Lowe, Donna Luff, Kathy Mazor, Patricia McGaffigan, Dale Micalizzi, Jennifer Moore, Suzanne Nevins, Sandy Novack, Madelene Ottosen, Margaret Plews-Ogan, Kate Reback, Bill Sage, Kenneth Sands, Barbara Sarnoff-Lee, Leilani Schweitzer, Sue Sheridan, Eric Thomas, Charles Vincent, Saul Weingart.

Funding

This conference was funded by an Agency for Healthcare Research and Quality conference grant, R13HS024463. Additional support was provided by The Risk Authority, Stanford; Medically Induced Trauma Support Services; and Beth Israel Deaconess Medical Center.

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Authors and Affiliations

  1. Harvard Medical School, Boston, MA, USA

    Elizabeth Gaufberg & Sigall K. Bell

  2. The Cambridge Health Alliance, Cambridge, MA, USA

    Elizabeth Gaufberg

  3. University of Vermont, Burlington, VT, USA

    Molly Ward Olmsted

  4. Beth Israel Deaconess Medical Center, Boston, MA, USA

    Sigall K. Bell

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  1. Elizabeth Gaufberg
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Correspondence to Elizabeth Gaufberg.

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This paper describes the opening exercise of a Conference, the full proceedings of which were published in the Joint Commission Journal in 2018 (Bell et al). Participation in all aspects of the conference was voluntary, and participants were fully aware that the intended outcome of the conference was publication(s) of the proceedings. All quotes were deidentified. Additionally, participants could choose to exclude their quotes at the end of the conference.

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Gaufberg, E., Olmsted, M.W. & Bell, S.K. Third Things as Inspiration and Artifact: A Multi-Stakeholder Qualitative Approach to Understand Patient and Family Emotions after Harmful Events. J Med Humanit 40, 489–504 (2019). https://doi.org/10.1007/s10912-019-09563-z

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