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Preventable Error Reporting Hindered by Fear of Reprisal

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

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