Disclosure of medical errors

Mazor, Kathleen M.; Reed, George W.; Yood, Robert A.; Fischer, Melissa A.; Baril, Joann L.; Gurwitz, Jerry H.

doi:10.1111/j.1525-1497.2006.00465.x

Cited by 115 publications

(26 citation statements)

References 38 publications

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“…Moreover, once an error occurs, effective communication is a fundamental component of the disclosure process 34-36,. Similar to previous researchers, we believe that interpersonal skills, empathy, and humanism can and should be included in the educational process and incorporated into multifaceted assessments to promote longer lasting change among trainees and physicians 6,7,34,35. The strong correlation between the scores in the humanistic behavior and medical error disclosure domains reinforces the crucial role of compassion and empathy in the externalization of medical errors to patients 8,34-36,39…”

Section: Discussionsupporting

confidence: 83%

“…This finding conflicts with the ethical standards and expectations of professional guidelines and accrediting organizations, all of which dictate that physicians have a responsibility to disclose medical errors to patients34 to enhance transparency in healthcare 12. The failure to provide truthful and compassionate explanations to patients and their relatives after medical errors occur decreases patient trust and satisfaction in healthcare 35,36. Patients and families want to be told about any error that causes patient harm 34,38,39.…”

Section: Discussionmentioning

confidence: 99%

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A new method for the assessment of patient safety competencies during a medical school clerkship using an objective structured clinical examination

Daud-Gallotti

Morinaga

Arlindo-Rodrigues

et al. 2011

Clinics

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INTRODUCTION:Patient safety is seldom assessed using objective evaluations during undergraduate medical education.OBJECTIVE:To evaluate the performance of fifth-year medical students using an objective structured clinical examination focused on patient safety after implementation of an interactive program based on adverse events recognition and disclosure.METHODS:In 2007, a patient safety program was implemented in the internal medicine clerkship of our hospital. The program focused on human error theory, epidemiology of incidents, adverse events, and disclosure. Upon completion of the program, students completed an objective structured clinical examination with five stations and standardized patients. One station focused on patient safety issues, including medical error recognition/disclosure, the patient-physician relationship and humanism issues. A standardized checklist was completed by each standardized patient to assess the performance of each student. The student's global performance at each station and performance in the domains of medical error, the patient-physician relationship and humanism were determined. The correlations between the student performances in these three domains were calculated.RESULTS:A total of 95 students participated in the objective structured clinical examination. The mean global score at the patient safety station was 87.59±1.24 points. Students' performance in the medical error domain was significantly lower than their performance on patient-physician relationship and humanistic issues. Less than 60% of students (n = 54) offered the simulated patient an apology after a medical error occurred. A significant correlation was found between scores obtained in the medical error domains and scores related to both the patient-physician relationship and humanistic domains.CONCLUSIONS:An objective structured clinical examination is a useful tool to evaluate patient safety competencies during the medical student clerkship.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

A new method for the assessment of patient safety competencies during a medical school clerkship using an objective structured clinical examination

Daud-Gallotti

Morinaga

Arlindo-Rodrigues

et al. 2011

Clinics

View full text Add to dashboard Cite

show abstract

“…However, in these hypothetical situations, there was not a consistent effect on intent to seek legal advice; this intent was instead predicted by the nature of the error and the level of harm 14 . Other studies yielded similar conclusions: 12 ,19, 20 full disclosure generally leads to a more positive patient response, but certain patient reactions (such as intent to seek legal advice) may be more affected by the event and the harm than by the level of disclosure.…”

Section: Introductionmentioning

confidence: 88%

Disclosure of Adverse Events in the United States and Canada: An Update, and a Proposed Framework for Improvement

Boyle

Wallace

et al. 2013

Journal of Public Health Research

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There is consensus that physicians, health professionals and health care organizations should discuss harm that results from health care delivery (adverse events), including the reasons for harm, with patients and their families. Thought leaders and policy makers in the USA and Canada support this goal. However, there are gaps in both countries between patients and physicians in their attitudes about how errors should be handled, and between disclosure policies and their implementation in practice. This paper reviews the state of disclosure policy and practice in the two countries, and the barriers to full disclosure. Important barriers include fear of consequences, attitudes about disclosure, lack of skill and role models, and lack of peer and institutional support. The paper also describes the problem of the second victim, a corollary of disclosure whereby health care workers are also traumatized by the same events that harm patients. The presence of multiple practical and personal barriers to disclosure suggests the need for a comprehensive solution directed at multiple levels of the health care system, including health departments, institutions, local managers, professional staff, patients and families, and including legal, health system and local institutional support. At the local level, implementation could be based on a translating-evidence-into-practice framework. Applying this framework would involve the formation of teams, training, measurement and identification of local barriers to achieving universal disclosure of adverse events.Significance for public healthIt is inevitable that some patients will be harmed rather than helped by health care. There is consensus that patients and their families must be told about these harmful events. However, there are gaps between patient and physician attitudes about how errors should be handled, and between disclosure policies and their implementation. There are important barriers that impede disclosure, including fear of consequences, attitudes about disclosure, lack of skill, and lack of institutional support. A related problem is that of the second victim, whereby health care workers are traumatized by the same harmful events. This can impair their performance and further compromise safety. The problem is unlikely to be solved by focusing solely on increasing disclosure. A comprehensive solution is needed, directed at multiple levels of the health care system, including health departments, institutions, local managers, professional staff, patients and families, and including legal, health system and local institutional support.

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“…But the process of disclosure itself has only recently received significant attention in the research literature 17 . Patients tend to report that they prefer mistakes and errors be disclosed, and report likelihood of greater satisfaction and likelihood of returning to the same physician 18-20 . Apologies are extraordinarily complex and brittle speech acts 21-23 .…”

Section: Introductionmentioning

confidence: 99%

(Re)Introducing Communication Competence to the Health Professions

Spitzberg

2013

Journal of Public Health Research

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Despite the central role that communication skills play in contemporary accounts of effective health care delivery in general, and the communication of medical error specifically, there is no common or consensual core in the health professions regarding the nature of such skills. This lack of consensus reflects, in part, the tendency for disciplines to reinvent concepts and measures without first situating such development in disciplines with more cognate specialization in such concepts. In this essay, an integrative model of communication competence is introduced, along with its theoretical background and rationale. Communication competence is defined as an impression of appropriateness and effectiveness, which is functionally related to individual motivation, knowledge, skills, and contextual facilitators and constraints. Within this conceptualization, error disclosure contexts are utilized to illustrate the heuristic value of the theory, and implications for assessment are suggested.Significance for public healthModels matter, as do the presuppositions that underlie their architecture. Research indicates that judgments of competence moderate outcomes such as satisfaction, trust, understanding, and power-sharing in relationships and in individual encounters. If the outcomes of health care encounters depend on the impression of competence that patients or their family members have of health care professionals, then knowing which specific communicative behaviors contribute to such impressions is not merely important – it is essential. To pursue such a research agenda requires that competence assessment and operationalization becomes better aligned with conceptual assumptions that separate behavioral performance from the judgments of the competence of that performance.

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Disclosure of medical errors

Cited by 115 publications

References 38 publications

A new method for the assessment of patient safety competencies during a medical school clerkship using an objective structured clinical examination

A new method for the assessment of patient safety competencies during a medical school clerkship using an objective structured clinical examination

Disclosure of Adverse Events in the United States and Canada: An Update, and a Proposed Framework for Improvement

(Re)Introducing Communication Competence to the Health Professions

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