A survey of hospital leaders indicates that many have serious reservations about a mandatory error reporting system, including that it would discourage event reporting and increase the risk of lawsuits, according to a recent study. The Institute of Medicine has recommended establishing both mandatory and voluntary reporting systems for health care institutions such as hospitals and nursing homes. The purpose of reporting is to collect data on a broad range of events to detect systemic problems that can be altered to reduce the risk of patient harm. As of October 2003, 21 states had mandatory event reporting systems for hospitals, although policies varied.
Joel S. Weissman, PhD, a researcher with the Institute for Health Policy at Massachusetts General Hospital in Boston, and colleagues conducted a study to elicit the views of hospital executives with regard to mandatory state reporting systems and closely related issues of patient safety.1 The researchers surveyed chief executive and chief operating officers (CEOs/COOs) from randomly selected hospitals in two states with mandatory reporting and public disclosure, two states with mandatory reporting without public disclosure, and two states without mandatory systems in 2002-03.
Responses were received from 203 of 320 hospitals (a response rate of 63%). The researchers found that most CEOs/COOs thought that a mandatory, nonconfidential system would discourage reporting of patient safety incidents to their hospital’s own internal reporting system (69%) and encourage lawsuits (79%) while having no effect or a negative effect on patient safety (73%). More than 80% felt that the names of both the hospital and the involved professionals should be kept confidential, although respondents from states with mandatory public disclosure systems were more willing than respondents from the other states to release the hospital name (22% vs. 4% to 6%).
State standards have influence
When presented with hypothetical clinical vignettes, more than 90% of hospital leaders said their hospital would report incidents involving serious injury to the state, but far fewer would report moderate or minor injuries, even when the incident was of sufficient consequence that they would tell the affected patient or family.
"In the hospital setting, executive leaders influence institutional policy and foster norms for their employees," the authors wrote. "These individuals believe that existing state reporting standards fail in some cases to provide clear guidance on what should be reported and that mandatory reporting systems with public disclosure may actually discourage internal reporting, lead to lawsuits, and impart little benefit to patient safety. Hospital leaders, of course, have their own institutional biases, and there is some evidence that hospitals that become accustomed to transparency may eventually grow to be more accepting of it. However, if hospital leaders continue to harbor negative views of reporting, it is unlikely that state mandatory reporting systems will be highly successful in the long run."
Reference
1. Weissman JS, Annas CL, Epstein AM, et al. Error reporting and disclosure systems: Views from hospital leaders. JAMA 2005; 293(11):1,359-361,366.
A survey of hospital leaders indicates that many have serious reservations about a mandatory error reporting system, including that it would discourage event reporting and increase the risk of lawsuits, according to a recent study.
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