Physician Attitudes Toward Reporting Errors
Abstract & Commentary
By Leslie A. Hoffman, PhD, RN, Department of Acute/Tertiary Care, School of Nursing, University of Pittsburgh, is Associate Editor for Critical Care Alert.
Dr. Hoffman reports no financial relationship to this field of study.
Synopsis: In this study of US physicians, because of dissatisfaction with current systems, practitioners were more likely to discuss errors with colleagues than to report them to patient safety programs, resulting in lost opportunities for system change.
Source: Garbutt J, et al. Health Affairs. 2008; 27(1):246-255.
This study reports findings from a survey of 1,082 US physicians (62% response rate) regarding their attitudes about reporting medical errors and suggestions for ways to prevent common errors. All respondents were clinically active physicians in medicine and surgery, employed in 15 academic and community hospitals. Of the respondents, 56% reported prior involvement with a serious error, 74% with a minor error, and 66% with a "near miss." The majority agreed that "medical errors are usually caused by failure of the care delivery system, not failures of individuals." While agreeing that they should report errors (92%), and interested in learning about errors as a means to improve patient safety (95%), physicians were more likely to discuss serious errors, minor errors or near misses with their colleagues than to report them to risk management or a patient safety program.
Few respondents (27%) received any information from their hospital's risk management department or patient safety program about error circumstances. Most (70%) believed the current system was inadequate. Surgeons were less likely than other specialists to agree that errors were attributable to system failure rather than individual failure, or to indicate that they would report a serious error. However, surgeons were more likely to discuss serious errors with their colleagues.
Suggestions to improve reporting included: keeping information confidential and non-discoverable (88%), receiving feedback that illustrated how the information had been used for system improvement (85%), and making the system highly efficient (< 2 minutes to report) (66%) and individualized to their unit or department (53%).
Commentary
Contrary to conventional wisdom that physicians and other health care providers are reluctant to report errors, the majority of respondents to this survey were willing to report errors but viewed systems currently in place to be inadequate. Almost half (45%) did not know whether a system to improve patient safety existed in their hospital or health care organization. Consequently, they were more likely to share information with their colleagues than to use institutional reporting systems. While individually helpful, this approach does not provide input that can be used to make system-wide change. Important information remains invisible to the health care system.
Findings from this study have implications for efforts to improve patient safety. Systems need to be developed that emphasize the value of reporting to achieve quality improvement. Rather than limiting the report to a chronology of events, the system should ask respondents to identify ways to avoid a similar event in the future. It would also be helpful if the system encouraged efforts to report "near misses", which are more frequent than serious errors, as a means of identifying ways to prevent more serious errors.
Two key factors motivating dissatisfaction with current reporting systems were lack of feedback and lack of confidence that the information reported would actually be used to make improvements. When individuals have limited knowledge of changes (if any) that were made to repair the system, they are unlikely to take the time to report errors. Today, most systems for reporting errors are uniform throughout the institution. Reporting systems that are specialty-specific may be more desirable and helpful in promoting change, than institutionally based systems. It is unlikely that patient safety will be improved until we critically evaluate current approaches and develop new systems that consider the preferences of those who are asked to use them.
This study reports findings from a survey of 1,082 US physicians (62% response rate) regarding their attitudes about reporting medical errors and suggestions for ways to prevent common errors.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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