Do hospital bosses live in terror of error reporting?

Mar 14, 2005

Forcing healthcare institutions to disclose errors to state agencies only inspires a mum staff and more lawsuits, while doing little to ensure patient safety, according to a survey of hospital executives from six U.S. states. In addition, there's varied interpretation of what constitutes a reportable mistake.

"Despite potentially worthwhile aspects of mandatory reporting, our results suggest that most hospital leaders had serious reservation about these (error reporting) systems," wrote Joel Weissman, Ph.D., and colleagues in the Journal of the American Medical Association. "These individuals believe that existing state reporting standards fail ... to provide clear guidance on what should be reported ..." (JAMA, March 16, 2005, Vol. 293:11, pp. 1359-1366).

Weissman is from the Institute for Health Policy at Massachusetts General Hospital in Boston. His co-authors are from multiple Boston-based institutions such as Harvard Medical School, Brigham and Women's Hospital, and the Massachusetts Department of Public Health, as well as Brown University in Providence, RI.

For this survey, Weissman's group selected a sample of acute cure, nonfederal hospitals in Massachusetts, Colorado, Pennsylvania, Florida, Georgia, and Texas. At the time of the study (November 2002 to March 2003), the first three states had mandatory, nonconfidential reporting systems. Floridians were required to report adverse events to a state agency. Georgia and Texas had no system in place, although that is no longer the case, the authors stated.

A questionnaire was sent to hospital CEOs (83% of respondents; 63% response rate) and COOs (17% of respondents; 41% response rate). The questions focused on areas such as public disclosure of error reporting systems, whether nonconfidential systems encouraged or discouraged reporting as well as lawsuits, and a reduction in hospital errors. The authors also asked if those error reports should be forwarded to the affected patients and/or their families.

Finally, the respondents were presented with three vignettes of hypothetical errors, ranging from uneventful to bad (mistake corrected) to worse (error-related death).

According to the survey results, 69% of these hospital leaders responded that a state-run mandatory, nonconfidential reporting system discourages their employees from admitting to mistakes. In addition, 79% thought that such a system encouraged lawsuits. Finally, 73% believed that mandatory reporting had little effect on patient safety.

In terms of the state systems that were in place during the survey period, 23% of respondents declared that the reporting criteria were unclear. Also, as many as 69% of the respondents stated that they were less like to report cases with a "less severe" injury, despite mandatory, nonconfidential reporting laws.

However, between 38% and 57% said that they would let patients know about less severe injuries, even if the state were never informed. With regard to the hypothetical vignettes, between 84% and 100% of the respondents said that they would inform a patient's family about an error-related death.

Overall, the survey showed that administrators do consider patient safety a priority, but that their greater loyalty is to the patient, not the state. "Responses to our vignettes revealed that hospital leaders were more likely to disclose moderate or minor incidents to their patients than to the state," the authors wrote. "A majority of respondents gave 'very high' priority in their hospitals to finding out the root cause of patient harm (83%)."

The authors offered suggestions for making hospital bosses more amenable to state-run reporting systems:

Culling data from the hospital community at large and analyzing for trends and systemic problems
Clarifying definitions of reportable events
Granting hospitals protected access to a database of reported incidents with all identifying names removed

"If hospital leaders continue to harbor negative view of reporting, it is unlikely that state mandatory systems will be highly successful," the group cautioned.

By Shalmali Pal
AuntMinnie.com staff writer
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