Intended for healthcare professionals

News Roundup [abridged Versions Appear In The Paper Journal]

Doctors mistrust systems for reporting medical mistakes

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7456.12-d (Published 01 July 2004) Cite this as: BMJ 2004;329:12
  1. Caroline White
  1. London

    UK doctors do not trust NHS monitoring systems designed to report medical mistakes, a representative survey of 2500 doctors has found.

    The survey, carried out by the doctors' online network, Doctors.net.uk, indicates that although eight out of 10 respondents had witnessed a colleague making a mistake, few were apparently willing to use the available systems to report it.

    One in 10 of the 100 000 strong membership of Doctors.net.uk were surveyed in June to gauge their views on reporting medical mistakes. The survey, which was designed to adequately reflect gender and differing geographical areas and levels of seniority, included family doctors and hospital specialists.

    The survey did not specifically ask about “near misses,” but responses showed that only 15% of serious incidents resulting in death or serious disability were reported to existing schemes.

    Respondents were not asked to give their reasons, but Dr Neil Bacon, who founded Doctors.net.uk, said there were “pages and pages of free text” about previous bad experiences of pointing out errors, including blame and witch hunts.

    Almost all (97%) of the 2575 respondents felt that a reporting system would improve patient care, but eight out of 10 said they did not trust their employing NHS trust or the Department of Health to run it. Instead, almost all respondents favoured a system that was completely independent.

    “There is a shockingly low level of trust,” said Dr Bacon, “and I hope the responses reflect comments about the old reporting systems,” he said.

    The National Patient Safety Agency began its roll-out of a new, confidential, and anonymous reporting system (the National Reporting and Learning System) across NHS trusts in England and Wales last November, with full implementation by the end of this year.

    “Doctors aren't sufficiently aware of [the new reporting system] or the National Patient Safety Agency,” said Dr Bacon, adding that the online service and the agency had agreed to meet to discuss the findings in more depth in mid-July. “Collaboration is key in this area,” he said.

    A spokeswoman for the agency said that it was committed to raising awareness among the medical profession, but she acknowledged that it would take time to win the trust of healthcare staff.

    “The move to a fully open and fair culture will take time to achieve,” she added.

    Commenting on the findings, the BMA's chairman, James Johnson, said: “If you can find out why something has gone wrong and share that information you can stop it happening again … The important thing is to alert everyone to a problem area so that patients are safeguarded in future.”