In recent years, a growing number of hospitals have developed reporting systems to allow staff to report both medical errors, near-misses and other safety incidents after they occur. By encouraging staff to speak up about the day-to-day ups and downs of the clinical process, patient safety experts argue that hospitals can identify potential gaps in quality and initiate performance improvement efforts before a major incident occurs. By their very nature, the key to the success of these monitoring systems is buy-in from clinical staff, who are often the ones charged with reporting errors and near-misses.


But a new survey published by Johns Hopkins suggests that the fear of embarrassment and potential professional trouble may be keeping many clinicians from reporting these critical issues. The survey, which solicited responses from physicians, nurses and radiation specialists at three U.S. hospitals, found that few nurses and physicians said they routinely submitted online reports on errors and near-misses. For respondents who did not use error reporting systems, getting colleagues into trouble, potential liability and the fear of embarrassment in front of co-workers were all cited as potential barriers.

In a statement that accompanied the report, researcher Kendra Harris, M.D., an oncology radiation resident at Johns Hopkins, said that the key to persuading clinicians to participate — and not avoid reporting at all costs — lies in assuring them that the reports are there to illuminate systemic issues and find solutions, not to identify and punish staff for mental lapses.

"These systems should not be viewed as punitive; rather, they're a critical way to improve therapy," says Harris. "You can't manage what you can't measure."

On the other hand, 90 percent of respondents told Johns Hopkins researchers they'd observed near-misses or errors, and most respondents agreed that error reporting is their responsibility.

"Respondents recognized that error events should be reported and that they should claim responsibility for them," Harris says. "The barriers we identified are not insurmountable."

While the Johns Hopkins survey is unscientific, I was intrigued to learn that many clinicians are still distrustful of reporting near-misses and errors. Any time I see a presentation on error reporting or listen to an advocate describe a reporting system, the impression I get is that no serious system includes any punitive action or identification for voluntary reporting. Many health care systems, after all, model their safety and error reporting systems on the Crew Resource Management tactics used by the airline industry, which emphasize empowering all members of the team to speak up about potential lapses or near-misses. So it's somewhat surprising to learn that fear of being singled out or punished for reporting potential harm is still a barrier for many clinicians.

Additional information on the survey is available here.

Haydn Bush is senior online editor for Hospitals & Health Networks Magazine.