Recurring problems must come to light in order to be corrected -- that's why any tendency to cover up medical errors for fear of liability is incredibly dangerous. In 2000, the Institute of Medicine reported that medical errors kill up to 98,000 people each year. According to the set of patient safety standards issued by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2001, preventing medical errors requires "an environment in which patients, their families, and organization staff and leaders can identify and manage actual and potential risks to patient safety."
But how comfortable do hospital employees feel in reporting errors by their coworkers? In 2002, Gallup asked 3,700 employees at four different hospitals if the staff members at their facilities are willing to report medical errors. While these results should not be considered representative of the national healthcare employee population as a whole, they do provide considerable insight on the issue.
The good news is that 64% of employees surveyed either "agree" or "strongly agree" (giving a score of 4 or 5 on a scale of 1 to 5) that staff members at their facilities are willing to report medical errors. Thirty-three percent of employees "strongly agree" with this statement. However, 12% of employees either "disagree" or "strongly disagree" (giving a score of 1 or 2 on a 5-point scale) that staff members are willing to report medical errors.
Why Don't Staff Members Report Errors?
In order to achieve improved patient safety, the JCAHO guidelines note, staff members and leaders must work together to identify and manage patient safety risks. Gallup's data from these four hospitals indicate that a majority of employees agree that staff members at their hospitals are willing to accept this responsibility and report medical errors. But about one in eight employees is not so confident. Given the seriousness of the issue, that number may strike many as too high.
One would certainly assume that mission-driven healthcare employees are well aware of the seriously adverse impact that medical errors can have, and are sensitive to the need to prevent them. It is unlikely that staff members fail to report medical errors simply because they don't care about the patients' safety.
A more likely explanation is that some employees may hesitate to report medical errors because of misguided feelings of loyalty toward their fellow coworkers, or a fear of being labeled a "whistleblower." Successful healthcare delivery requires strong teamwork and coworker trust. Reporting a coworker's medical error may be viewed as disloyal to the team, since reporting errors generates unwanted paperwork and could potentially get team members in trouble. Staff members may feel that the cost of reporting an error is too great, especially if they feel that the error in question was minor and did not have serious repercussions.
To address the potential barriers to staff reporting of medical errors, hospitals must emphasize the importance of errors as a serious healthcare issue. Early identification of "minor" errors is a key ingredient to the quality improvement process and could prevent potentially grave errors in the future. Systems should be in place to protect the identity of staff members who report medical errors.
But improving the reporting process is not enough. Employees who are not engaged in their work may fail to use even the most user-friendly of systems for reporting errors. Therefore, managers must work to raise levels of employee engagement in their workgroups, by making their employees feel that their opinions count, helping employees to feel that their fellow coworkers are committed to quality, and reinforcing the idea that error prevention is a central part in achieving the overall mission of improving the health status of the community.