I've observed, and lecture on, the behavorial "drivers" of stakeholders in clinical IT such as the EMR. In my talks I speak of a resistance of hospital executives at the C-level and in middle management (including medical staff) towards clinical IT on the basis of what I term the "report card fear." This fear involves the exposure of medical errors and the effects on a medical center's reputation, with all that implies. In that light, I find this article interesting and confirmatory of my empirical observations:
Hospital Leaders Leery of Error Reporting
Tue Mar 15
By LINDSEY TANNER, AP Medical Writer
CHICAGO - Many hospital administrators are leery of the push toward mandatory reporting of medical errors, saying such practices will lead to more lawsuits and ultimately less openness without improving patient safety, a survey found.
The 2002-03 survey of 203 chief executives and chief operating officers was published in Wednesday's Journal of the American Medical Association . More than 80 percent said if reporting to a state agency were required, the identities of the offending hospitals and doctors should be kept confidential.
Almost 70 percent said a state-run, mandatory, nonconfidential reporting system would make doctors and other hospital staff less likely to reveal their own errors.
Only 28 percent said a nonconfidential system would benefit patient safety, and 79 percent said such a system would encourage lawsuits, despite evidence that patients are less likely to sue if doctors admit their mistakes and apologize.
"That message has not gotten out to the hospital community," said lead author Joel Weissman, a researcher at Massachusetts General Hospital's Institute for Health Policy.
At least 21 states had mandatory reporting systems when the study was conducted and at least 11 protected the confidentiality of those involved, the researchers said.
The Institute of Medicine, an independent group that advises the government, in 1999 recommended establishing both mandatory and voluntary reporting systems to reduce medical errors, which it said kill up to 98,000 hospitalized Americans each year.
Dr. Carolyn Clancy, director of the federal Agency for Healthcare Research and Quality, which funded the survey, said the findings highlight the conflict facing hospital administrators.
"There's a big push for transparency" in health care, Clancy said. And while patients should be told about errors, she said, whether that information should be made public is an open question.
Dr. Peter Slavin, president of Massachusetts General Hospital, said mandatory reporting promotes accountability, but if done with the intent to punish, it can "send a lot of people underground" and make them reluctant to disclose a mistake.
"The real challenge is finding the right balance," said Slavin, who was not surveyed. Administrators in Colorado, Florida, Georgia, Massachusetts, Pennsylvania and Texas were surveyed by telephone.
Participants from states that had mandatory reporting were generally more supportive of nonconfidential reporting than those from states without, Weissman said. "Familiarity breeds acceptance," he said.
When presented with hypothetical scenarios about medical errors, nearly all participants said they would tell patients and the state, if mandatory reporting existed, about errors resulting in serious harm, such as a severe reaction to the wrong antibiotic. Fewer said they would report less serious errors.