A Conceptual Model for Disclosure of Medical Errors
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY ROCKVILLE MD
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Objective Patient safety is fundamental to high-quality patient care. Critical steps toward improving the safety of the health care system include ensuring that the system is aware of its errors so that effective remedies can be applied, and enhancing the trustworthiness of the health care system for patients by disclosing errors that are meaningful to them. This study aimed to construct a conceptual model of the factors that facilitate or hinder disclosure of medical errors. Methods We conducted 25 separate focus groups with attending physicians, nurses, residents, patients, and hospital administrators at 5 academic medical centers in a university health care system. The protocol probed the ethical perceptions of participants and the details of disclosure expectations. Audiotapes of the focus groups were transcribed and analyzed using Atlas.ti software. Codes were assigned to the text in an iterative fashion. Themes were identified and assembled into a model of disclosure. Results All groups believed that errors should be disclosed. Important influences on whether disclosure would occur fell into four categories provider factors, patient factors, error factors, and institutional culture. Provider issues included perceived professional responsibility, fears, and training. Patient factors included their desire for information, level of health care sophistication, and rapport with their provider. Error factors included level of harm and whether patients and others were aware of the error and the harm. Perceived tolerance for error and a supportive infrastructure were institutional factors that influenced disclosure. Conclusion This grounded model of error disclosure delineates areas for interventions to increase disclosure as a step toward improving patient safety.
- Medicine and Medical Research
- Computer Programming and Software
- Safety Engineering