ABSTRACT
Objective
Patient safety is fundamental to high-quality patient care. Critical steps toward improving the safety of the health care system include ensuring the system is aware of its errors so 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 five 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.
A Conceptual Model for Disclosure of Medical Errors
