Minimizing Medical Errors: A Qualitative Analysis of Health Care Providers' Views on Improving Patient Safety

Executive Summary Following the Institute of Medicine's publication of the seminal work To Err is Human: Building a Safer Health System, researchers began exploring patient safety from a variety of perspectives. Yet few studies have asked front-line care providers about their perceptions of health care attributes that facilitate or present barriers to patient safety. The present study examined qualitative data collected in a larger study of patient and health care provider perceptions of patient safety. This study focuses on responses to two open-ended questions from a survey of employees working at three hospitals (n=1,098). One question asked about conditions respondents felt increased the chances for medical errors, and the other asked about conditions that decreased the chances for errors. Results indicated consistent themes across the three hospitals, although the relative importance of some themes differed across the hospitals. "Staffing" was the top concern across each hospital when it came to conditions respondents felt could lead to an increase in medical errors, and "policies and procedures" was second. However, "policies and procedures" was considered the top approach that decreased medical errors across all three hospitals. Despite the common factors, some themes unique to each hospital were found. Results suggest that regular, anonymous, qualitative feedback from care providers could be a useful diagnostic tool for understanding organizational attributes that increase or decrease chances for preventable adverse medical events. Introduction Patient safety means that people can expect to receive health care with minimal risk of encountering a preventable adverse medical event or medical error. Medical error has been described as "a chronic threat to public health, as lethal as breast cancer, motor vehicle accidents, or AIDS. " (Berwick, 2002, p.81). Unfortunately, the risk of death by medical error has become one of the nation's leading causes of death. The number of deaths each year in the United States due to preventable medical errors has been likened to "the equivalent of three jumbo jets crashing every two days" (seeker-Walker & Taylor Adams, 2001, p. 419). Following the Institute of Medicine's (IOM) publication of the seminal work To Err is Human: Building a Safer Health System (Kohn, Corrigan & Donaldson, 2000), researchers began exploring patient safety from a variety of perspectives (James, 2005; Leape & Berwick, 2005). Much patient safety research has revolved around the investigation of clinical indicators. This research is often based on retrospective root cause analysis following a serious adverse medical event (Reason, 2001). Root cause analysis often uncovers a series of latent errors, none of which could have caused the event on its own (Chassin & Becher, 2002; Leape, Gallivan, Nemeskal, Shea, & Vliet, 1995). Although such analysis can identify specific errors that occur in specific situations, there is still a lack of theory, consistent measures, and empirical research on this important issue. Errors are not documented consistently, even within one organization (Savitz, Jones, & Bernard, 2005). This can lead to inaccurate information about where problems lie in the organization (Antonow, Smith, and Sliver, 2000; James, 2005). Scholars have decreased the emphasis on individual incompetence and begun to focus more on systems approaches for increasing patient safety (Reason, 2000, 2001 ; Schyve, 2005). However, Hoff, Jameson, Hannan, and Fink (2004) found few published empirical studies linking systems approaches to improved outcomes. Thinking of patient safety in terms of typical quality indicators has also not resulted in consistent measures across instruments or provider groups. In fact, Savitz, Jones, and Bernard (2005) concluded that there is currently no "unified direction" (p.383) for development of patient safety indicators. Few, if any, empirical studies have specifically asked front-line health care providers what they see as key contributors to preventable adverse medical events. …