Race Differences in Reported “Near Miss” Patient Safety Events in Health Care System High Reliability Organizations

Abstract

Objectives: This study aimed to determine if race differences exist in voluntarily reported near-miss patient safety events in a large integrated, 10-hospital health care system on its journey to become a high reliability organization.

Race Differences in a Malpractice Event Database in a Large Healthcare System

“…Our finding of race differences in potential malpractice events as reported by healthcare staff (“observations”) in this malpractice database is consistent with the race differences we found in our previous studies of employee reports of harmful patient safety events and near misses using a voluntary occurrence reporting database 17,18 . In these previous studies, we found that healthcare staff are significantly more likely to report near misses and patient safety events that harmed the patient when the patient is White and less likely when the patient is Black 17,18 .…”

“…Our finding of race differences in potential malpractice events as reported by healthcare staff (“observations”) in this malpractice database is consistent with the race differences we found in our previous studies of employee reports of harmful patient safety events and near misses using a voluntary occurrence reporting database 17,18 . In these previous studies, we found that healthcare staff are significantly more likely to report near misses and patient safety events that harmed the patient when the patient is White and less likely when the patient is Black 17,18 . This correlation showing race differences in 2 different methods for reporting risk to patients, potential harm to patients, or actual patient harm suggests that reporting method may not be a significant factor influencing employees’ decision of whether to notify the healthcare system of a potential adverse patient safety event.…”

“…17,18 In these previous studies, we found that healthcare staff are significantly more likely to report near misses and patient safety events that harmed the patient when the patient is White and less likely when the patient is Black. 17,18 This correlation showing race differences in 2 different methods for reporting risk to patients, potential harm to patients, or actual patient harm suggests that reporting method may not be a significant factor influencing employees' decision of whether to notify the healthcare system of a potential adverse patient safety event. Moreover, our findings could potentially indicate that employee observations accurately reflect that healthcare staff observe more potential malpractice events for White patients.…”

“…Indeed, Black patients have been found to be more likely to experience adverse events such as hospital-acquired infections and delayed diagnoses, whereas both Black and White patients have been found to experience more postsurgical complications than patients of other races 11–16 . In addition, by stratifying data in voluntary occurrence reporting systems by race, healthcare system employees reported fewer harmful and near-miss safety events involving Black patients and more events involving White patients than expected based on the race proportions in the overall healthcare system patient population 17–19 . However, whether race differences in patient safety events translate to race differences in reports of potential malpractice events, medical malpractice claims, and lawsuits remains largely unknown.…”

“…[11][12][13][14][15][16] In addition, by stratifying data in voluntary occurrence reporting systems by race, healthcare system employees reported fewer harmful and near-miss safety events involving Black patients and more events involving White patients than expected based on the race proportions in the overall healthcare system patient population. [17][18][19] However, whether race differences in patient safety events translate to race differences in reports of potential malpractice events, medical malpractice claims, and lawsuits remains largely unknown. The objective of this study was to determine whether potential malpractice events reported by healthcare system employees (also known as "observations") or involving claims (i.e., claims of malpractice made by a patient or their representative not yet involving the court), or lawsuits (i.e., malpractice claims that ultimately involved the court system) differ based on patient race.…”