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This paper looks at a number of approaches to health informatics that support decision‐making relevant to the integrated development and management of information systems with clinical and managerial practices in healthcare. Its main aim is to explore three such approaches for integrated development, the soft information systems and technologies methodology, participative simulation modelling and stakeholder analysis. A description of the health informatics research and development environment in the UK is given as necessary background to the paper. Organisational and social aspects are examined through these approaches including information and clinical process development, telemedicine, ethical issues of drug use and management, health policies and information management and strategies, tele‐education and modelling structures. In the conclusion the synergies between the three approaches are discussed and some principles are extracted for future research and development in integrated approaches to health informatics research.

The purpose of this paper is to provide international data on the occurrence (and rates) of clinical errors, identified by type and consequence in the Lombardy region, and to assess empirically the association between hospital accreditation‐type measures and clinical error rates by merging hospital discharge records and medical malpractice claim data in the Lombardy region (Italy).

Data were drawn from the regional database collecting claims and demands for reimbursement declared by patients hospitalized in regional healthcare structures and regional archives collecting hospital discharge records. To model the variability of clinical errors rates, binomial negative regression models were applied. For improved interpretation of the results, a regression tree methodology was used.

The results demonstrated that the rate of readmission for the same major diagnostic category and the rate of discharges against medical advice significantly affect the incidence of errors causing patient death, whereas the rate of unscheduled surgical readmission in the operating room significantly affects the rate of surgical error.

The findings confirm that claims data is problematic in nature because of the limited number of claims generally emerging from administrative sources. The article proposes using proper regression models for count data, taking into account over‐dispersion and excess zeroes and classification tree methods for a better interpretation of empirical evidence.

Health structures where quality outcomes have a significant impact on clinical error rates should be monitored in depth, investigating the medical charts of involved patients to identify quality problems and problematic areas.

As a risk management strategy, the combined use of claims data and clinical administrative data is proposed to shed light on the more problematic, error‐prone areas, allowing regional stakeholders to receive relevant, highly cost‐effective and timely information and an in‐depth understanding of the problematic areas in the assessment of risk.

The aim of this paper is to determine the available remedies for medical negligence instances in Bangladesh.

This research work is qualitative in nature. Books, journal articles, case law and statutory laws have been reviewed to formulate this work.

A victim of medical negligence in Bangladesh can approach the court seeking remedy under the Criminal Law, Civil Law and Constitutional Law. Moreover, medical professionals are expected to be aware about the legal consequences of their medically negligent practices, and they should indulge in ethical practices so as to avoid getting embroiled in controversial situations and litigations.

The main reasons for unaccountability of medical practitioners include the unwillingness of people to initiate action against medical practitioners and the lack of legal knowledge about the remedies for medical negligence instances. This paper will assist in gather the required legal knowledge.

Explores the relationship between doctors, lawyers and the government in the context of the explosion in clinical negligence litigation, clinical governance and the introduction of the Human Rights Act 1998. Examines these issues from a legal perspective. Concludes that successful risk management, careful monitoring and the implementation of authoritative guidelines hold the key to legal change.

This, the first of three papers, provides an overview of the law of negligence as it affects medical practitioners in the UK. The standard of care owed by doctors to patients is considered in the light of recent increases in malpractice claims, the escalating cost of medical insurance and current Government proposals for Crown indemnity.

Public reports of provider-specific patient outcomes aim to help consumers select suppliers of medical services. Yet, in an environment of rapidly changing medical technology and increasingly heterogeneous patient populations, and because they necessarily reflect the experience of other patients who received care in the past, such reports may be of limited value in helping patients forecast the probability of an adverse outcome for each provider they are considering. I propose that providers underwrite insurance policies that promptly pay patients a predetermined sum after an adverse outcome. Patients can use such outcome warranties to infer quality differences among providers easily and reliably. In addition, outcome warranties efficiently reward both providers and patients for reducing the risk of adverse outcomes and thereby improve the safety and affordability of health care. As such, outcome warranties help advance four important goals of health care management: reduction of financial risk, recruitment and retention of physicians, remediation of adverse outcomes, and raising the provider's reputation.

The routine use of intrapartum electronic fetal monitoring (EFM) has resulted in an increased burden of operative and vaginal instrumental deliveries for women at low obstetric risk. Such modes of delivery increase maternal mortality and morbidity risks. This study aims to explore midwives' values, attitudes and beliefs when using intrapartum fetal monitoring techniques in clinical practice.

A total of 58 registered midwives across two NHS Trusts in one region in the north of England were interviewed using a qualitative approach.

Midwives attempted to manage the psychological burden of the threat from clinical negligence by using EFM. This meant that some midwives used electronic monitoring regardless of clinical need. Midwives lack confidence in the ability of EFM to accurately detect fetal compromise but are aware that the visual monitoring record is recognised as a valuable piece of legal evidence. The midwives' perceptions of professional self‐efficacy in seeking to avoid a claim in clinical negligence contributed to defensive practice. Research limitations/implications – The study was conducted in only two hospitals in one region of England; however the Trust demographics were similar and midwifery practice within the unit reflects national maternity standards of care.

Multidisciplinary strategies may be required to overcome barriers to the effective implementation of clinical guidelines where intrapartum fetal monitoring is concerned and Trust audit departments must undertake regular audit cycles in order to ascertain practice compliance with best evidence.

The paper provides information so that midwives' knowledge regarding the limitations of EFM can be improved.

Clinical guidelines from National Institute of Clinical Excellence (NICE) have been developed by a rigorous process using the highest‐level evidence base. Their objectives are to reduce the variations in clinical care and end the postcode lottery of healthcare delivery. They are backed strongly by the government's agenda, are expected to be implemented and to be monitored, and this is to be monitored by CHAI. Up until now, clinical guidelines have had a secondary status to expert witness testimony in determining the standard of care in law in medical litigation. However, guidelines from NICE may have a more influential role in determining the standard of care in law by setting the standard of expected clinical practice. Trusts need to be sensitive to this as part of their risk management strategy. Trusts should facilitate the implementation of guidelines from NICE and audit their use through the framework of clinical governance. In the rare event that a trust should decide to positively diverge from such guidelines, it should do so only through a mechanism of due process that is required in public law for the accountability of the reasonableness of such a decision.