Importance  Dissatisfaction with medical malpractice litigation has stimulated interest by health care organizations in developing alternatives to meet patients’ needs after medical injury. In communication-and-resolution programs (CRPs), hospitals and liability insurers communicate with patients about adverse events, use investigation findings to improve patient safety, and offer compensation when substandard care caused harm. Despite increasing interest in this approach, little is known about patients’ and family members’ experiences with CRPs.

Objective  To explore the experiences of patients and family members with medical injuries and CRPs to understand different aspects of institutional responses to injury that promoted and impeded reconciliation.

Design, Setting, and Participants  From January 6 through June 30, 2016, semistructured interviews were conducted with patients (n = 27), family members (n = 3), and staff (n = 10) at 3 US hospitals that operate CRPs. Patients and families were eligible for participation if they experienced a CRP, spoke English, and could no longer file a malpractice claim because they had accepted a settlement or the statute of limitations had expired. The CRP administrators identified hospital and insurer staff who had been involved in a CRP event and had a close relationship with the injured patient and/or family. They identified patients and families by applying the inclusion criteria to their CRP databases. Of 66 possible participants, 40 interviews (61%) were completed, including 30 of 50 invited patients and families (60%) and 10 of 16 invited staff (63%).

Main Outcomes and Measures  Patients’ reported satisfaction with disclosure and reconciliation efforts made by hospitals.

Results  A total of 40 participants completed interviews (15 men and 25 women; mean [range] age, 46 [18-67] years). Among the 30 patients and family members interviewed, 27 patients experienced injuries attributed to error and received compensation. The CRP experience was positive overall for 18 of the 30 patients and family members, and 18 patients continued to receive care at the hospital. Satisfaction was highest when communications were empathetic and nonadversarial, including compensation negotiations. Patients and families expressed a strong need to be heard and expected the attending physician to listen without interrupting during conversations about the event. Thirty-five of the 40 respondents believed that including plaintiffs’ attorneys in these discussions was helpful. Sixteen of the 30 patients and family members deemed their compensation to be adequate but 17 reported that the offer was not sufficiently proactive. Patients and families strongly desired to know what the hospital did to prevent recurrences of the event, but 24 of 30 reported receiving no information about safety improvement efforts.

Conclusions and Relevance  As hospitals strive to provide more patient-centered care, opportunities exist to improve institutional responses to injuries and promote reconciliation.

重要性  对医疗事故诉讼的不满激发了医疗保健组织对开发替代方案以满足医疗事故后患者需求的兴趣。在沟通与解决方案（CRP）中，医院和责任保险公司与患者就不良事件进行沟通，利用调查结果提高患者安全性，并在不合格的医疗服务造成伤害时提供赔偿。尽管人们对这种方法越来越感兴趣，但对患者及其家庭成员使用CRP的经验知之甚少。

目的  探讨患有医疗伤害和CRP的患者及其家属的经验，以了解机构对促进和阻碍和解的伤害的应对措施的不同方面。

设计，设置和参与者  从2016年1月6日至6月30日，在美国3家运营CRP的医院对患者（n = 27），家庭成员（n = 3）和工作人员（n = 10）进行了半结构化访谈。如果患者和家属经历了CRP，会说英语并且不再因接受和解或时效期限已过而提起医疗事故索赔，则有资格参加。CRP管理员确定了参与CRP事件并与受伤患者和/或家人有密切关系的医院和保险公司工作人员。他们通过将纳入标准应用于他们的CRP数据库来识别患者和家属。在66名可能的参与者中，完成了40次访谈（61％），包括50名受邀患者和家属中的30名（60％）和16名受邀员工中的10名（63％）。

主要结果和指标  患者报告对医院所做的披露和和解工作感到满意。

结果  共有40位参与者完成了访谈（15位男性和25位女性；平均[范围]年龄为46 [18-67]岁）。在接受采访的30位患者及其家庭成员中，有27位患者因错误而受伤，并获得了赔偿。30位患者及其家庭成员中有18位的CRP总体经验是积极的，有18位患者继续在医院接受治疗。当沟通是善解人意且非对抗性的，包括赔偿谈判时，满意度最高。患者和家属表达了强烈的倾听需求，并希望主治医生在对事件的交谈过程中不会打扰到他们。在40位受访者中，有35位认为在这些讨论中包括原告律师是有帮助的。在30名患者和家属中，有16名认为他们的补偿是适当的，但17名报告称该提议没有足够的积极性。患者和家属强烈希望知道医院为防止该事件再次发生所做的事情，但是30名患者中有24名报告没有收到有关改善安全性措施的信息。

结论和相关性  随着医院努力提供更多以患者为中心的护理，存在改善机构对伤害的反应并促进和解的机会。