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Medical Error Self-Reporting Stifled by Fears of Retaliation

 |  By John Commins  
   June 06, 2011

It's been established that one effective method for improving patient safety is to create an environment where staff are encouraged to self-report medical errors without fear of retaliation.

So, it was surprising to see a recent HR Solutions survey that found that while 70% of healthcare employees believe they can report a medical/healthcare error caused by a colleague without fear of reprisal, only 54% said they can report an error they themselves have caused without fear of retaliation.

And, only 65% of healthcare employees in the survey said they would be supported by their supervisors if they committed a medical error. The study analyzed survey responses from nearly 300,000 healthcare employees at 160 hospitals and health systems throughout the nation, so this is an impressive sampling.

What does it say about the state of employee relations and engagement if more than half of healthcare employees fear retaliation?

One big obstacle for creating an open, engaged workforce might be workers' fear of retaliation from front line supervisors, says Rick Lovering, the vice president for Human Resources and Organizational Development at AtlantiCare in Egg Harbor Township, NJ. It's not enough, he says, for a CEO to declare a zero-tolerance policy on retaliation from a lofty perch in the c-suite. That policy has to be instilled in every manager in a healthcare organizations.

"You do it through constant education and constant reinforcement," Lovering says. "I'm a firm believer that the conversation can drive the culture, so if you keep talking about these things and why we don't want to have a punitive response to errors people buy into it."

Lovering says AtlantiCare engages its managers as coaches and mentors for the staff they supervise. "So if someone makes a patient safety error that would be a coaching-for-improvement opportunity. That is the way we view it and we have taught our supervisors to view it that way," he says.

But even that isn't enough to protect employee confidence from the occasional "rogue manager," Lovering says. Employees must have a safe outlet to vent their concerns about retaliation. So, AtlantiCare contracted with an outside company that fields Intranet complaints from staff about supervisors – or any other area of hospital operations. Employees who complain have the option of remaining anonymous.

At first, the idea that employees would be able to anonymously complain about their bosses didn't sit well with supervisors. "We heard a lot about 'how am I going to prevent employees from making me look bad, saying things that aren't happening?'"

Lovering says. "I've had very little of that. I tell managers 'if you are creating an environment where employees want to sabotage your career that says something about the environment you are creating.'"

Where it can get tricky, however, is with the repeat offenders, the worker who repeatedly makes serious medical errors that could endanger patients. Sometimes, those honest errors point to an unpleasant reality.

"Clearly if we had an employee that had multiple errors, ultimately you might have to get past retraining and have a discussion about if they're cut out for that kind of work," Lovering says. "We have been fortunate and not had to go down that road with our staff yet."

AtlantiCare's programs to ease staff anxiety about self-reporting medical errors are similar to the efforts of hundreds of other hospitals across the country. This is not a new issue. So why is there such a high level of distrust among staff, several years into these initiatives? How much of it is residual, and how much of it is warranted?  

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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