Medical error reporting: professional tensions between confidentiality & liability.

Improving patient safety depends on a sophisticated understanding of what can jeopardize it. Reports of adverse patient events and “near misses” constitute valuable information that can foster that understanding. Knowing what has gone wrong in the past facilitates the search for systems improvements, which can prevent recurrence. Unfortunately, providers have been generally unenthusiastic about reporting medical error, whether from a sense of shame, from a fear of liability and institutional sanctions, or from anxiety about reputation and relationships with peers. This Issue Brief lays out the factors that may affect reporting, and explores the limited evidence about whether providers’ confidentiality and liability concerns do in fact negatively affect their willingness to report, and if so, what might be done to improve the situation. This Issue Brief describes the two current mandatory mechanisms for reporting medical error in Massachusetts hospitals, one public and one confidential, along with the limited available evidence about their effectiveness. This imperfect information points toward the conclusion that confidentiality guarantees make little difference concerning what actually gets reported. This Issue Brief also describes three voluntary reporting mechanisms, all with at least initial confidentiality guarantees, and the even more incomplete evidence concerning their effectiveness. This Issue Brief then examines the relationship between reporting and liability exposure, noting that whether liability fears in fact deter reporting and whether confidentiality guarantees actually encourage it are far from clear. Here again, the limited information available makes it difficult to conclude that increased confidentiality protection or immunity from malpractice liability will be sufficient to improve either reporting behavior or patient safety programs. No-fault medical error compensation mechanisms are explored, and this report concludes that although such systems may be valuable for providing more efficient and equitable compensation to more injured patients, their positive impact on physician reporting behavior is at best questionable. Evaluating the empirical effect of any law on provider propensity to report is very difficult, and most of the discussion in the literature thus far has been based on assumption. Moreover, the societal objective of accountability and notice to the profession must be achieved through some other means when a no-fault system is enacted, and those alternative means (such as increased Board of Registration oversight) may have their own chilling effect on reporting. This Issue Brief’s key recommendation is to pursue this opportunity to conduct more research on ways to encourage provider participation in reporting adverse patient events, in order …