Since the early 1990s, much has been learned about medical errors in health care settings, and about their impact on illness, death, and costs, according to background information in the article. Although a number of approaches to reduce errors were proposed, a key strategy involved the use of reporting systems to identify and learn from errors. The Institute of Medicine has recommended establishing both mandatory and voluntary reporting systems for health care institutions such as hospitals and nursing homes. The purpose of reporting is to collect data on a broad range of events to detect systemic problems that can be altered to reduce the risk of patient harm. As of October 2003, 21 states had mandatory event reporting systems for hospitals, although policies varied.
Joel S. Weissman, Ph.D., of the Institute for Health Policy, Massachusetts General Hospital, Boston, and colleagues conducted a study to elicit the views of hospital executives with regard to mandatory state reporting systems and closely related issues of patient safety. The researchers surveyed chief executive and chief operating officers (CEOs/COOs) from randomly selected hospitals in 2 states with mandatory reporting and public disclosure, 2 states with mandatory reporting without public disclosure, and 2 states without mandatory systems in 2002-2003.
Responses were received from 203 of 320 hospitals (response rate=63 percent). The researchers found that most CEOs/COOs thought that a mandatory, nonconfidential system would discourage reporting of patient safety incidents to their hospital's own internal reporting system (69 percent) and encourage lawsuits (79 percent) while having no effect or a negative effect on patient safety (73 percent). More than 80 percent felt that the names of both the hospital and the involved professionals should be kept confidential, although respondents from states with mandatory public disclosure systems were more willing than respondents from the other states to release the hospital name (22 percent vs. 4 to 6 percent).
When presented with hypothetical clinical vignettes, more than 90 percent of hospital leaders said their hospital would report incidents involving serious injury to the state, but far fewer would report moderate or minor injuries, even when the incident was of sufficient consequence that they would tell the affected patient or family.
"In the hospital setting, executive leaders influence institutional policy and foster norms for their employees. These individuals believe that existing state reporting standards fail in some cases to provide clear guidance on what should be reported and that mandatory reporting systems with public disclosure may actually discourage internal reporting, lead to lawsuits, and impart little benefit to patient safety. Hospital leaders, of course, have their own institutional biases, and there is some evidence that hospitals that become accustomed to transparency may eventually grow to be more accepting of it. However, if hospital leaders continue to harbor negative views of reporting, it is unlikely that state mandatory reporting systems will be highly successful in the long run," the authors write.
(JAMA. 2005;293:1359-1366. Available post-embargo at JAMA.com)
Editor's Note: This work was supported by a cooperative agreement from the Agency for Healthcare Research and Quality.