Race Differences in Reported Harmful Patient Safety Events in Healthcare System High Reliability Organizations

Abstract

Objectives The aim of the study was to determine whether race differences exist in voluntarily reported harmful patient safety events in a large 10 hospital healthcare system on a high reliability organization journey. Methods From July 1, 2015, to June 30, 2017, employees in a healthcare system based in Washington, District of Columbia, and Maryland voluntarily reported harmful patient safety events by type using a Patient Safety Event Management System. Inpatients, outpatients, and observation patients were identified as “black,” “white,” or “other” (N = 5038). Using retrospective analysis and χ2 goodness of fit, comparisons of race proportions were conducted to determine differences at the health system level, by hospital, by event type, and by severity. Results Significant race differences existed: (1) overall with higher proportions of whites and lower proportions of other in a Patient Safety Event Management System; (2) by type across races; (3) in six hospitals across races; and (4) by type and by hospital for blacks and whites. All differences were significant at P < 0.05. Conclusions Race differences in harmful events exist in voluntary reporting systems by type and by hospital setting. Healthcare organizations, particularly healthcare high reliability organizations, can use these findings to help identify areas of further study and investigation. Further study and investigation should include efforts to understand the root cause of the differences found in this study, including the role of reporting bias.

Diagnostic error experiences of patients and families with limited English-language health literacy or disadvantaged socioeconomic position in a cross-sectional US population-based survey

“…Organisations should empower translators and interpreters to report safety events. They should also routinely track race, ethnicity, literacy, socioeconomic position and other sociodemographic factors within their safety reporting systems and patient-reported concerns (such as patient complaints) in order to learn more about the experiences of populations at risk of safety disparities, recognising that error-based reporting may be underestimated among more vulnerable groups 2 60…”

Inpatient patient safety events in vulnerable populations: a retrospective cohort study

“…Unlike in our study, Thomas et al did not compare this system with another to identify patient safety events, but the authors suspected that this finding may have represented under-reporting of events among minority patients. 25 There are several possible explanations for such under-reporting. Safety events may be more visible to providers if they occur in a White, English speaking patient.…”

“…This will result in lack of recognition of events and may disproportionally impact these more vulnerable populations, which, in turn, could exacerbate existing health disparities. 25 There are strengths in voluntary reporting systems compared with automated reporting systems, but it is important for health systems to be mindful of the shortcomings of voluntary systems and make concerted efforts to address these shortcomings. In particular, given the current sociopolitical climate, many healthcare systems are re-enforcing their efforts to address bias and structural racism in order to improve health equity.…”

The High Cost of Harm

“…Patients' racial and ethnic differences offer an additional layer of complexity as patient safety outcomes vary on the basis of race, ethnicity, and social determinants of health. 7,8 As evidence highlighting inequities in safety events grows, 9 we would like to see further reexamination of the CMS payment structure by including disincentives or penalties for inequities in patient outcomes based on racial, ethnic, or socioeconomic differences. Medicaid, in recent years, has dedicated efforts to support states with designing and implementing programs and services to address social determinants of health 10 ; patient safety outcomes fall within this initiative.…”

“…In addition, bias in voluntary event reporting continues to minimize the number of documented safety events, creating greater inequity within populations of at-risk patients. 9 Minimizing these biases and encouraging equity in reporting mechanisms would likely lead to overall improvements in patient outcomes.…”