Development of a framework to describe patient and family harm from disrespect and promote improvements in quality and safety: a scoping review

Lauge Sokol-Hessner; Gregory J Kane; Catherine L Annas; Margaret Coletti; Barbara Sarnoff Lee; Eric J Thomas; Sigall Bell; Patricia Folcarelli

doi:10.1093/intqhc/mzy231

Development of a framework to describe patient and family harm from disrespect and promote improvements in quality and safety: a scoping review

Int J Qual Health Care. 2019 Nov 30;31(9):657-668. doi: 10.1093/intqhc/mzy231.

Authors

Lauge Sokol-Hessner^{1

2}, Gregory J Kane³, Catherine L Annas^{1

4}, Margaret Coletti⁵, Barbara Sarnoff Lee⁶, Eric J Thomas^{7

8}, Sigall Bell², Patricia Folcarelli¹

Affiliations

¹ Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, MA, USA.
² Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
³ Admissions Office, Boston University School of Public Health, Boston, MA, USA.
⁴ Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁵ Knowledge Services, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁶ Department of Social Work and Patient-Family Engagement, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁷ Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA.
⁸ University of Texas at Houston-Memorial Hermann Center for Healthcare Quality and Safety, McGovern Medical School at the University of Texas Health Sciences Center at Houston, TX, USA.

PMID: 30428052
DOI: 10.1093/intqhc/mzy231

Abstract

Purpose: Patients and families may experience 'non-physical' harm from interactions with the healthcare system, including emotional, psychological, socio-behavioral or financial harm, some of which may be related to experiences of disrespect. We sought to use the current literature to develop a practical, improvement-oriented framework to recognize, describe and help prevent such events.

Data sources: Searches were performed in PubMed, Embase, PsychINFO, CINAHL, Health Business Elite and ProQuest Dissertations & Theses: Global: Health & Medicine, from their inception through July 2017.

Study selection: Two authors reviewed titles, abstracts, full texts, references and cited-by lists to identify articles describing approaches to understanding patient/family experiences of disrespect.

Data extraction: Findings were evaluated using integrative review methodology.

Results of data synthesis: Three-thousand eight hundred and eighty two abstracts were reviewed. Twenty three articles were identified. Components of experiences of disrespect included: (1) numerous care processes; (2) a wide range of healthcare professional and organizational behaviors; (3) contributing factors, including patient- and professional-related factors, the environment of work and care, leadership, policies, processes and culture; (4) important consequences of disrespect, including behavioral changes and health impacts on patients and families, negative effects on professionals' subsequent interactions, and patient attrition from organizations and (5) factors both intrinsic and extrinsic to patients that can modify the consequences of disrespect.

Conclusion: A generalizable framework for understanding disrespect experienced by patients/families in healthcare may help organizations better prevent non-physical harms. Future work should prospectively test and refine the framework we described so as to facilitate its integration into organizations' existing operational systems.

Keywords: disrespect; incident reporting and analysis; patient-centred care; qualitative methods; quality improvement.

Publication types

Review

MeSH terms

Family / psychology
Humans
Patient Safety*
Patient Satisfaction
Patient-Centered Care
Professional-Patient Relations*
Professionalism
Quality of Health Care*