Barriers and Motivators for Making Error Reports from FM Offices
Barriers and Motivators for Making Error Reports from FM Offices
Context: Reporting of medical errors is a widely recognized mechanism for initiating patient safety improvement, yet we know little about the feasibility of error reporting in physician offices, where the majority of medical care in the United States is rendered.
Objective: To identify barriers and motivators for error reporting by family physicians and their office staff based on the experiences of those participating in a testing process error reporting study.
Design: Qualitative focus group study, analyzed using the editing method.
Setting: Eight volunteer practices of the American Academy of Family Physicians National Research Network.
Participants: 139 physicians, nurse practitioners, physician assistants, nurses, and staff who took part in 18 focus groups.
Instrument: Interview questions asked about making reports, what prevents more reports from being made, and decisions about when to make reports.
Results: Four factors were seen as central to making error reports: the burden of effort to report, clarity regarding the information requested in an error report, the perceived benefit to the reporter, and properties of the error (eg, severity, responsibility). The most commonly mentioned barriers were related to the high burden of effort to report and lack of clarity regarding the requested information. The most commonly mentioned motivator was perceived benefit.
Conclusion: Successful error reporting systems for physicians' offices will need to have low reporting burden, have great clarity regarding the information requested, provide direct benefit through feedback useful to reporters, and take into account error severity and personal responsibility.
The reporting of medical errors or events is an essential activity for improving patient safety, not just in hospitals but in ambulatory care settings as well. Error reports "channel attention, shape interpretations and serve as springboards for action." Error reporting is one of several mechanisms for identifying areas needing improvement. A strength of error reporting is that it occurs on the front lines of care and, therefore, has the potential to increase mindfulness of safety issues as they occur in real time. A weakness is that most errors are not reported. Many reasons have been proposed for this underreporting, including underrecognition, confusion about definitions, fear of blame and punishment, concerns about anonymity and confidentiality, and the amount of time and effort required to report. In addition, a belief that reporting will make no difference has also been cited as a reason for underreporting. Less is known about what encourages health care personnel to make reports.
With the passage of the Patient Safety and Quality Improvement Act of 2005, it is likely that error and event reporting will spread from hospitals, where it is common, to ambulatory care settings, where it rarely occurs and is not part of routine work. As with most patient safety research, the majority of work on error reporting has been performed in a hospital setting. There is, however, a small body of literature about error reporting from primary care practices. For example, Beasley and Karsh explored what 14 family physicians and office staff would like in an error reporting system.
To better delineate the factors for successfully reporting errors in an ambulatory care setting, we chose to draw from the experiences of family physicians and their office staff who were participating in an errors reporting study. We held focus groups at the participating offices to discuss their experiences with making error reports, specifically looking for barriers to and motivators for reporting errors.
Context: Reporting of medical errors is a widely recognized mechanism for initiating patient safety improvement, yet we know little about the feasibility of error reporting in physician offices, where the majority of medical care in the United States is rendered.
Objective: To identify barriers and motivators for error reporting by family physicians and their office staff based on the experiences of those participating in a testing process error reporting study.
Design: Qualitative focus group study, analyzed using the editing method.
Setting: Eight volunteer practices of the American Academy of Family Physicians National Research Network.
Participants: 139 physicians, nurse practitioners, physician assistants, nurses, and staff who took part in 18 focus groups.
Instrument: Interview questions asked about making reports, what prevents more reports from being made, and decisions about when to make reports.
Results: Four factors were seen as central to making error reports: the burden of effort to report, clarity regarding the information requested in an error report, the perceived benefit to the reporter, and properties of the error (eg, severity, responsibility). The most commonly mentioned barriers were related to the high burden of effort to report and lack of clarity regarding the requested information. The most commonly mentioned motivator was perceived benefit.
Conclusion: Successful error reporting systems for physicians' offices will need to have low reporting burden, have great clarity regarding the information requested, provide direct benefit through feedback useful to reporters, and take into account error severity and personal responsibility.
The reporting of medical errors or events is an essential activity for improving patient safety, not just in hospitals but in ambulatory care settings as well. Error reports "channel attention, shape interpretations and serve as springboards for action." Error reporting is one of several mechanisms for identifying areas needing improvement. A strength of error reporting is that it occurs on the front lines of care and, therefore, has the potential to increase mindfulness of safety issues as they occur in real time. A weakness is that most errors are not reported. Many reasons have been proposed for this underreporting, including underrecognition, confusion about definitions, fear of blame and punishment, concerns about anonymity and confidentiality, and the amount of time and effort required to report. In addition, a belief that reporting will make no difference has also been cited as a reason for underreporting. Less is known about what encourages health care personnel to make reports.
With the passage of the Patient Safety and Quality Improvement Act of 2005, it is likely that error and event reporting will spread from hospitals, where it is common, to ambulatory care settings, where it rarely occurs and is not part of routine work. As with most patient safety research, the majority of work on error reporting has been performed in a hospital setting. There is, however, a small body of literature about error reporting from primary care practices. For example, Beasley and Karsh explored what 14 family physicians and office staff would like in an error reporting system.
To better delineate the factors for successfully reporting errors in an ambulatory care setting, we chose to draw from the experiences of family physicians and their office staff who were participating in an errors reporting study. We held focus groups at the participating offices to discuss their experiences with making error reports, specifically looking for barriers to and motivators for reporting errors.
