Hospitals and other healthcare organizations have done a good job in the last 20 years building mechanisms to monitor and report preventable errors. However, those efforts are hobbled by clinicians’ reluctance to report colleagues’ mistakes for fear of retaliation, according to a new report from the National Association for Healthcare Quality.
“In fact, as attention to creating a culture of safety in healthcare organizations has increased, so have concomitant reports of retaliation and intimidation targeting staff who voice concern about safety and quality deficiencies,” according to the report, Call to Action: Safeguarding the Integrity of Healthcare Quality and Safety Systems.
Peter Angood, MD, CEO of the American College of Physician Executives, which helped compile the report, says the fear of retaliation is “very distinct and quite palpable in many organizations to the point that there is even a fear of making comment” about the existence of the threat.
“It is multi-factorial,” Angood tells HealthLeaders Media. “Some of it comes from historical orientation of hospitals and healthcare systems towards the physicians and making sure they are happy and as long as they are happy there is good patient flow and everybody wins.
As we transition off of that entire focus toward physicians and more towards patients there are the lingering cultural habits of not wanting to cross the physician’s path if things aren’t going right.”
Angood says the fear of retaliation is also rooted in the traditional risk management models that hospitals have used for years.
“Risk management programs in hospitals historically have been oriented to protect the hospital from legal action. So in many places, not all, there is a fear from the administration and the risk management offices of receiving reports because it becomes discoverable information and the potential for legal liability,” he says.
“Once that tone is set it doesn’t take much for the workforce to recognize that reporting can be harmful for the institution. So they won’t report.”
Angood believes the fear of retaliation will wane in the long run as more physicians become hospital employees, “but we will probably go through a little dip and then move on to a projection of improvement.”
“That dip will occur because the existing physician workforce and many in the non-physicians workforce are caught in the trap of fear of reporting and the pressure for models of care change,” he says.
“As employed physicians get used to that, there will be an increased level of education and awareness on the benefits of tackling errors and safety problems head on with improved reporting. Other industries have recognized that good reporting strategy leads to improvements in quality and safety and employed physicians will gradually bring that forward in healthcare systems.”
“On another level, if the reporting system is not oriented towards improving quality and transparently and safety then the reporting system is perceived as a ‘gotcha!'”
The report notes that new reimbursement models that diverge from fee-for-service and instead reward outcomes and patient satisfaction create an even greater need for strong infrastructures to collect accurate data and address patient safety concerns.
The report urges hospitals to:
- Focus on accountability for quality and safety as part of a strong and just culture.
- Build protective structures that encourage reporting quality and safety concerns.
- Compile transparent, accurate data and reporting to internal and external oversight bodies.
- Act on quality and safety concerns.
- Foster teamwork and open communication.
Even the best safety and reporting infrastructures may be stymied by an unwritten code of silence among clinicians and administrators, Angood says.
“The majority of care in this country is provided in hospitals of 300 beds or so and a lot of them are in smaller communities,” he says. “It goes back to the human behavior piece. If you are going to work with the folks you see at the gas station or out shopping are you going to report each other out? Likely not.”
Source: Health Leaders Media at http://www.healthleadersmedia.com/page-3/QUA-285666/Preventable-Error-Reporting-Hindered-by-Fear-of-Reprisal