Medical malpractice occurs when healthcare providers fail to meet accepted standards, causing patient harm. Globally, malpractice is addressed through civil, criminal, or combined legal actions. In Jordan, criminal liability can arise under the Penal Code and the Medical and Health Liability Law No. 25 of 2018. However, practical application remains underexplored.This study analyzes criminal medical malpractice cases in Jordan, examining legal frameworks, case features, and outcomes to inform healthcare and legal practice. A retrospective review of court verdicts from the Qistas database was conducted through January 2025. Eligible cases included criminal proceedings related to medical errors. Descriptive and inferential statistics were performed using Jamovi. Of 342 rulings, 180 cases met the inclusion criteria. Obstetrics and gynecology (27.1%), general surgery (15.8%), and emergency medicine (12.4%) were the most implicated specialties. Proven errors occurred in 54.5 % of cases; failure to follow professional standards was the leading cause. Regression analysis reveals the higher likelihood of conviction among female defendants. Jordanian courts emphasize professional fault over punitive intent in criminal malpractice cases. Strengthening expert committee roles, enforcing consistent use of the Medical Liability Law, and enhancing medicolegal education are crucial to ensure fair accountability and patient safety.
Burnout among hospitalists is a growing focus of quality improvement for hospitals around the United States. Burnout has been associated with decreased patient care quality, which may lead to decreased system sustainability. A gap remains however regarding burnout factors in certain region-specific populations such as central Michigan. The objective of this study is to examine the associations between burnout and a collection of potentially impactful variables including gender, age, marital status, years at work, and dependents. Four domains of burnout were investigated among hospitalists at MyMichigan Saginaw and Midland Health Systems. These domains included client-related, work-related, personal, and overall burnout. A cross-sectional study using Qualtrics surveys was used to assess burnout levels, including comparisons between married/partnered vs single/unpartnered physicians. Results showed that married/partnered hospitalists reported significantly lower client-related and overall burnout compared to their unmarried/unpartnered peers. These findings suggest an association between spousal support and improved resistance to physician burnout, but not against workplace-specific stressors. Future studies may assess a causal protective effect of spousal support against the emotional and interpersonal aspects of burnout. Hospitals should consider the benefits of relationship-aware support in their scheduling and work practices. Accommodating these may help improve hospitalist satisfaction and performance.
Diagnostic errors significantly impact patient outcomes and are often linked to dysfunctional team dynamics. Gaslighting, characterized by patterned distortion and doubt induction, is increasingly recognized among health care professionals and may compromise diagnostic safety. Traditionally examined in provider-patient relationships, gaslighting within teams remains underexplored. This concept analysis examines gaslighting within health care teams in the context of diagnostic safety, identifying its defining attributes, antecedents, consequences, and implications. The Walker and Avant method was used to guide this concept analysis. A systematic literature search was conducted across PubMed, CINAHL Plus with Full Text, Medline, PsycINFO, and Embase, yielding 12 articles meeting inclusion criteria. Extracted data were analyzed to identify common themes, focusing on gaslighting's characteristics, triggers, and outcomes within interprofessional teams. Gaslighting in health care teams is characterized by dismissiveness, undermining behavior, and induced doubt in colleagues' clinical judgments. Antecedents include hierarchical power structures, workplace stress, and poor communication. Consequences involve emotional distress, loss of trust, and increased risk of diagnostic error. Tools like the Gaslighting at Work Questionnaire may assist in assessment. Recognizing and addressing gaslighting is critical to improving diagnostic safety. Organizational strategies must support psychological safety, open dialogue, and professional respect.
Medication-related problems represent a substantial burden on healthcare systems. At the study hospitals, medication safety education is delivered through a multifaceted program. This study aimed to describe the multifaceted strategies implemented to promote reflective learning and to evaluate staff acceptance and demand in relation to learning content to facilitate future education planning. The clinical staff members, including medical and nursing/midwifery staff, were invited to complete an online satisfaction survey via Microsoft Forms. The survey included the role of clinical staff member, format of learning received recently, content of learning and impact on clinical practice, and feedback and suggestion over a 12-month period. A total 127 responses were received. Using a Likert scale, staff responded to different elements of satisfaction. Of the responses most respondents either agreed or strongly agreed that that the learning was relevant to practice (98%, 125/127), easy to understand (98%, 125/127), maintained interest (93.7%, 119/127), had a clear, achievable objective (96.8%, 123/127), and medication safety knowledge improved (93.7%, 119/127). Free-text responses demonstrated strong engagement; staff valued opportunities to learn from real-life medication incidents reported in the organization. This evaluation highlights that targeted, site-specific approaches were well received with staff reported improvements in knowledge.
BACKGROUND:Near miss is a key component of patient safety systems, enabling organizational learning without patient harm. This study assessed healthcare professionals' knowledge, attitudes, and practices (KAP) toward Near miss reporting. METHODS:A cross-sectional study was conducted using a validated self-administered online questionnaire. Descriptive statistics summarized responses, while chi-square, Mann-Whitney U, Kruskal-Wallis, and multiple regression analyses examined associations and predictors of KAP. RESULTS:A total of 500 healthcare professionals participated. Participants demonstrated moderate knowledge and positive attitudes; however, only 25% had ever reported a near miss. Higher knowledge and attitude scores were significantly associated with older age, postgraduate education, longer tenure, and leadership roles. Postgraduate education and leadership positions were significant predictors of higher knowledge and more positive attitudes. CONCLUSION:Despite favorable knowledge and attitudes, near miss underreporting persists. Targeted education, simplified reporting systems, and strengthened leadership engagement are essential to bridge the gap between awareness and practice and improve patient safety outcomes.
Journal of Healthcare Risk ManagementEarly View CASE LAW UPDATE Case law update Christopher J. Allman JD, CPHRM, DFASHRM, Corresponding Author Christopher J. Allman JD, CPHRM, DFASHRM [email protected] orcid.org/0000-0002-7281-6258 Director of Compliance & Privacy, Medically Home Group, Boston, USA Correspondence Christopher J. Allman, Medically Home Group, Boston, USA. Email: [email protected]Search for more papers by this authorMaggie Neustadt JD, CPHRM, FASHRM, Maggie Neustadt JD, CPHRM, FASHRM orcid.org/0009-0009-1421-1726 Vice President of Risk Management, BJC Health System, Saint Louis, USASearch for more papers by this author Christopher J. Allman JD, CPHRM, DFASHRM, Corresponding Author Christopher J. Allman JD, CPHRM, DFASHRM [email protected] orcid.org/0000-0002-7281-6258 Director of Compliance & Privacy, Medically Home Group, Boston, USA Correspondence Christopher J. Allman, Medically Home Group, Boston, USA. Email: [email protected]Search for more papers by this authorMaggie Neustadt JD, CPHRM, FASHRM, Maggie Neustadt JD, CPHRM, FASHRM orcid.org/0009-0009-1421-1726 Vice President of Risk Management, BJC Health System, Saint Louis, USASearch for more papers by this author First published: 15 July 2024 https://doi.org/10.1002/jhrm.21579 Summer 2024 No. 116 (44–1) Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Early ViewOnline Version of Record before inclusion in an issue RelatedInformation
Despite significant progress in patient safety, human error continues to occur at high rates in surgical settings. The Human Factors Analysis and Classification System (HFACS) offers a proactive lens to understand how and where errors emerge. This study examines HFACS's utility and reliability in categorizing and comparing human error in cardiovascular, orthopedic, trauma care, and neurosurgery. Observational data from cardiovascular, orthopedic, trauma, and neurosurgery cases were coded using HFACS by trained analysts applying unanimous, majority, and reconciled consensus strategies to assess interrater reliability. Across specialties, 98.25% of disruptions occurred at the "preconditions for unsafe acts," indicating latent failures. In cardiovascular surgery, 49.20% were linked to adverse mental states (e.g., cognitive overload, stress), 26.95% to physical environment issues, and 12.69% to crew resource management. Orthopedic surgery showed 68.75% of crew resource management failures, 19.47% personal readiness issues, and 5.87% environment stressors. Trauma care involved 61.38% crew resource management, 26.71% adverse mental states, and 10.33% team availability. Neurosurgery disruptions stemmed 59.42% from technological environment/layout and 35.92% from communication, coordination, and planning. HFACS is a reliable tool for categorizing human factors in diverse surgical environments. Findings highlight distinct latent failure profiles across specialties and underscore the importance of data driven specialty-specific safety interventions.
Personas have gained significant recognition in healthcare for their impact on improving patient needs and resources. Patient personas are detailed profiles of patients with similar common needs, preferences, goals, and behaviors. This review examined patient personas, explored current methodologies in persona creation, and identified gaps in existing methods. Then, we proposed future directions incorporating advanced techniques such as predictive analytics to enhance persona creation. We applied PRISMA guidelines, searched databases such as PubMed, Web of Science, and ScienceDirect for related articles, and found 1893 articles. After screening the articles using the inclusion and exclusion criteria, 24 articles published between 2013 onwards were selected for this review. Several studies have used either qualitative, quantitative, or mixed methods to create personas. Researchers have implied that the reliance on qualitative data can introduce bias that affects persona accuracy. This review highlights the crucial role of patient personas in improving healthcare delivery, and personas have been proven effective in reforming healthcare services to meet patient needs. Although patient personas have been utilized for over a decade, post-implementation evaluations are seldom addressed. Evidence suggests that there is a need for continuous improvement to improve patient outcomes and healthcare services.
Patient safety culture is a critical component of health care quality in nursing homes. Surveys on patient safety culture can be helpful tools to evaluate care. The aims of the study were to translate a survey on patient safety culture, namely, the Nursing Home Survey on Patient Safety Culture (NHSOPS 1.0) from English into Swedish and to adapt it to Swedish conditions and to validate the translation. The survey was translated into Swedish following the TRAPD translation process -translate, review, adjudicate, pre-test, and document, as suggested by the provider of the original survey. The validity of the items was measured by Cronbach's alpha. Some changes in wording were made according to Swedish conditions. A pre-test with staff working in nursing homes showed adequate results for the translation. In this pilot study, all items and questions were considered valuable for measuring patient safety and were therefore retained in the Swedish version. The translated survey may be a helpful tool for measuring patient safety in nursing homes and prompting staff to reflect on their workplaces.
This paper examines the legal complexities surrounding hospital liability for malpractice committed by independent-contractor physicians, particularly within high-risk emergency care contexts. Through rigorous doctrinal analysis of landmark US decisions including Stelzer v. Northwest Community Hospital (2023), Popovich v. Allina Health System (2020), and Estate of Essex v. Grant County Public Hospital District No. 1 (2024) alongside seminal Commonwealth judgments such as Woodland v. Swimming Teachers Association (UK, 2013) and Kondis v. State Transport Authority (Australia, 1984), the study evaluates how courts apply the doctrines of vicarious liability, nondelegable duty, and apparent authority in cases involving explicit consent disclaimers. Findings reveal significant judicial inconsistencies regarding whether clear contractual disclaimers fully absolve hospitals of institutional liability. To address this doctrinal ambiguity, the paper proposes a novel hybrid liability model that maintains the protective legal force of explicit disclaimers when patients genuinely comprehend their scope, while preserving hospitals' overarching nondelegable obligations to patient safety, particularly in emergency care. By aligning doctrinal reform and policy recommendations, such as multilayered consent strategies, rigorous contractor oversight, integrated communication protocols, and comprehensive governance-level audits with the aims of SDG3, this study offers an actionable framework to enhance healthcare transparency, accountability, and patient safety across contemporary health systems.
This letter to the editor responds to Bailey and Delchamps' recent article on integrating enterprise risk management (ERM) in fall-related injury prevention. We extend their framework to emergency departments (EDs), emphasizing the strategic advantage of initiating individualized fall risk assessment at the point of triage. Many high-risk indicators-such as anticoagulant use and cognitive impairment-are already accessible in ED settings and can be embedded into machine learning-supported tools like the Rothman index or fall triage score. We also highlight the financial implications of fall-related injuries originating in or near the ED, noting their potential to increase hospital length of stay and trigger non-reimbursable costs. The authors' inclusion of risk matrices and heat maps presents scalable opportunities for safety prioritization in dynamic ED environments. We conclude by recommending prospective validation of ERM-based approaches within level 1 trauma centers and invite collaboration to test the framework's effectiveness in real-world emergency settings.
The consistent promotion of a culture of respect and accountability in the workplace is vital to the success of healthcare organizations. However, the existing literature on practical strategies for addressing misconduct, particularly with respect to physician behavior, is relatively sparse. The aim of this review was to thus devise an evidence-based, empirical framework for the management and remediation of disruptive physician actions. Core themes on which to center the framework were initially identified based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. A MEDLINE search was undertaken to identify original peer-reviewed works using terms associated with unprofessionalism with the goal of building a foundational basis. Articles published from January 2014 to March 2025 and restricted to the English language were included. Among the 1123 original articles that entered the final selection process, 1112 were excluded because they were focused solely on the characterization of disruptive behavior (n = 429); limited to trainees (n = 277), limited to ancillary staff (n = 150); concentrated on prevention (n = 148); and described consequences (n = 108). A total of 11 original publications thus met criteria for inclusion and differed in their design, methods, and endpoints. The core themes that emerged for framework construction were expectation setting (four studies); climate/organizational analysis (three studies); peer involvement (two studies); and professional training (two studies). The feasibility of developing an evidence-based framework to address disruptive physician behavior was demonstrated. The management implications specific to risk are discussed.
The United States has the highest rate of maternal mortality of all industrialized countries. Maternal mortality is considered the "tip of the iceberg" and about 80% of cases are considered preventable. Approximately, 60,000 birthing people experience severe maternal morbidity each year. These cases provide hospitals an opportunity to identify areas to improve the quality and safety of care provided. Due to the highly specialized nature of obstetric care, the specialty is fraught with risk and associated with the most paid claims driving high organizational overhead costs related to legal defense, awards, and settlements. Risk Managers are well-positioned to support their organizations in improving the safety of perinatal care by advocating for the need to prioritize and intentionally focus and invest resources toward mitigating obstetric risk. This paper provides an overview of the strategies risk managers can deploy to support the development of a comprehensive obstetric safety program that can decrease malpractice claims, reduce health care costs, and ultimately improve patient outcomes specifically, via a proactive perinatal risk assessment.
The transition to a new emergency department (ED) facility can pose significant challenges to patient safety. This study utilized Colman et al.'s simulation-based clinical systems testing approach to identify latent safety threats (LSTs), ensure operational readiness, and enhance staff confidence in a newly constructed ED at an urban hospital. A three-stage framework comprising development, implementation, and evaluation phases was employed. A large-scale "day in a life" in situ simulation was conducted to test system integration and identify LSTs. Data from participants, observers, and facilitators were collected and analyzed to develop action plans. The simulation included 63 scenarios over 4 h, engaging 125 participants and 50 standardized patients. A total of 113 LSTs were identified, leading to the development of a detailed action plan. Feedback from staff was positive, with participants reporting increased confidence in providing safe patient care in the new facility. This approach successfully identified safety threats and enhanced staff preparedness, potentially informing future operational plans for transitions in healthcare facilities. The methodology and findings are generalizable to other healthcare facilities undergoing similar transitions, where system integration, safety evaluation, and staff readiness are key concerns.
Traditional fall prevention activities are not effective in preventing inpatient falls or injuries from falls. A knowledge of the five steps of Enterprise Risk Management (ERM) provides risk professionals with opportunities to apply them on an organization-wide basis to existing risks. The authors demonstrate how to apply the five steps of ERM to the common risk/patient safety issue of fall injury prevention. The authors completed a comprehensive literature review and identified predictors of injuries from falls. A comprehensive framework emerged which assists in predicting and preventing falls with injury in the inpatient setting. In combination of two or more, the following have been shown to predict injuries after falls: the use of oral anticoagulants, being born female, dementia, polypharmacy, the use of Fall Risk Increasing Drugs, urologic co-morbidities, and HIV positive status. When the ERM Process is applied to injury from falls, a Strategic Risk Response is created which assists the risk professional with application of the ERM process. Shifting focus from fall prevention to fall injury prevention, with the application of the ERM Process, creates value for the patient and the organization, and contributes to program success and sustainability.
