Patient characteristics and interventions associated with complaints and medico-legal claims

Claims seeking compensation for medical negligence may be filed against doctors by patients through civil litigation. For less serious events, or to express dissatisfaction with care, patients may also complain, either directly to their care provider or the provider’s employer, or to medical and other regulators and health complaints entities.

The purpose of this Evidence Check was to provide an evidence-based foundation to understand which patient factors influence complaints and what interventions can support a reduction in complaints, particularly in those instances where the care provided had not been below the expected standard and the complaint was not otherwise warranted. 44 studies applicable to the Australian healthcare system were reviewed.

This review found there were fourteen types of patient characteristics examined to determine the likelihood of making a medico-legal complaint or initiating a claim, however none demonstrated either strength or consistency of effect. The review noted that more prospective studies would improve the level of evidence. The review also identified seven types of interventions which targeted a reduction in claims and complaints against doctors, including CPD participation, medical remediation programs, shared decision-making, and simulation training. The evidence was consistent across these interventions in demonstrating reduced number and associated costs of claims, reduced number of complaints, and increased timeliness of claims/complaints management.

However, the strength of evidence was found to be very weak. The review noted that enhanced collection of patient characteristic data by regulation agencies, healthcare complaints entities and medical indemnity insurers may facilitate improved quality of research to inform risk management policy and practice.

Schultz TJ, Zhou M, Gray J, Roseleur J, Clark R, Mordaunt DA, Hibbert P, Patient characteristics and interventions associated with complaints and medico-legal claims: an Evidence Check rapid review brokered by the Sax Institute for Avant Insurance Limited, 2022.
doi:10.57022/lioq6047