A qualitative study examining mental health clinicians’ risk-related opinions before and after acquisition of knowledge about a serious adverse incident

Purpose Despite recent developments in the approach to investigating incidents in healthcare, the hindsight that comes from knowing the outcome is still likely to influence investigators. There is limited research examining the role of hindsight bias in relation to the investigation of adverse incidents in mental health settings. This study is the first addressing the nature of narrative explanations provided by individuals with hindsight in this process. The purpose of this study was to examine the process of judgment formation by clinicians when they are intially contemplating future harm and then making sense of past harmful incidents. Design/methodology/approach This study conducted 10 focus groups with 31 participants, who were asked to discuss matters around risk in relation to a case. They were then informed of one of three outcomes taking place (patient suicide, patient-perpetrated homicide or no adverse outcome) and continued to offer their opinions. Findings Thematic analysis of the transcribed focus group discussions identified three themes: “variability of future-based judgements”, describing a wide range in the nature of possible future outcomes and the certainty with which these views were held; “making meaning after the fact”, confirming the concept of hindsight bias but also revealing the phenomenon of altering one’s view in light of knowledge about the outcome and “personal and professional risk”, referring to a clinician’s concern for professional harm in the event of a serious adverse outcome resulting from their clinical practice. Originality/value These findings are relevant to improving approaches to investigating adverse clinical incidents, but also to the conceptualisation of risk and addressing wider system factors.