Study finds why hospitals are failing to confront medical errors

BMJ 2012; 345 doi: (Published 21 December 2012) Cite this as: BMJ 2012;345:e8651
  1. Bob Roehr
  1. 1Washington, DC

Researchers have identified why a model that helps to promote patients’ safety and reduce malpractice costs is not being more widely adopted by hospitals.

The University of Michigan Health System pioneered the three principle approach of “disclose, apologize, offer” more than a decade ago. The model proactively identifies unanticipated clinical outcomes, monitors their investigation and changes in practice, communicates with patients and manages remedial care, and offers compensation when warranted.

A new study published in the Milbank Quarterly looked at expanding this model to more locations under a grant from the Agency for Healthcare Research and Quality.1 The authors, primarily affiliated with Harvard Medical School, conducted a series of semistructured interviews with healthcare professionals in Massachusetts.

The authors quoted one interviewee as saying that the model was “a huge win for patients, [who] suffer as much as anybody in the courts, maybe more. It’ll be a huge win for providers emotionally. It will be a huge win from a financial perspective because the right people will be getting compensated in a more timely manner and there will be far less waste in the process.”

Barriers to wider adoption of the model fell into four broad categories. One was cultural: physicians have not been trained to acknowledge mistakes and apologize, and this was reinforced by a liability system that often penalized such action.

The second was legal barriers, such as immunity of charities under tort law and physicians’ fear of malpractice being reported to registries, which are increasingly publicized. Thirdly, logistical obstacles included the fragmentation of responsibility and liability insurance coverage among many independent players within the delivery of healthcare.

Finally, there were the political barriers of existing laws governing malpractice and compensation and also people with vested interests in maintaining the status quo.

“By handling unanticipated and unintended incidents and patient injuries honestly and proactively we’ve virtually eliminated groundless legal claims, allowing us to focus on issues that demand attention with clear vision and no more excuses,” commented Rick Boothman, executive director of clinical safety for the University of Michigan Health System.

“We fundamentally focus on putting patients and safety first,” he said, “and we believe other hospitals can do the same.”


Cite this as: BMJ 2012;345:e8651