BMJ Qual Saf doi:10.1136/bmjqs-2011-000530
  • Original research

Error disclosure: a new domain for safety culture assessment

  1. Eric J Thomas1
  1. 1The University of Texas Medical School, Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, USA
  2. 2Department of Medicine, University of Washington, Seattle, Washington, USA
  3. 3Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Jason M Etchegaray, Department of Internal Medicine, The University of Texas Medical School at Houston, 6410 Fannin St, UTPB 1100.42, Houston, Texas 77030, USA; jason.etchegaray{at}
  1. Contributors Conception and design: all authors; acquisition of data: JME, THG, BD and EJT; analysis and interpretation of data: JME, THG, SKB and EJT; drafting of manuscript: JME; critical revision: all authors; statistical analysis: JME; obtaining funding: JME and EJT; administrative, technical or material support: THG, SKB and BD; supervision: EJT.

  • Accepted 5 March 2012
  • Published Online First 5 May 2012


Objective To (1) develop and test survey items that measure error disclosure culture, (2) examine relationships among error disclosure culture, teamwork culture and safety culture and (3) establish predictive validity for survey items measuring error disclosure culture.

Method All clinical faculty from six health institutions (four medical schools, one cancer centre and one health science centre) in The University of Texas System were invited to anonymously complete an electronic survey containing questions about safety culture and error disclosure.

Results The authors found two factors to measure error disclosure culture: one factor is focused on the general culture of error disclosure and the second factor is focused on trust. Both error disclosure culture factors were unique from safety culture and teamwork culture (correlations were less than r=0.85). Also, error disclosure general culture and error disclosure trust culture predicted intent to disclose a hypothetical error to a patient (r=0.25, p<0.001 and r=0.16, p<0.001, respectively) while teamwork and safety culture did not predict such an intent (r=0.09, p=NS and r=0.12, p=NS). Those who received prior error disclosure training reported significantly higher levels of error disclosure general culture (t=3.7, p<0.05) and error disclosure trust culture (t=2.9, p<0.05).

Conclusions The authors created and validated a new measure of error disclosure culture that predicts intent to disclose an error better than other measures of healthcare culture. This measure fills an existing gap in organisational assessments by assessing transparent communication after medical error, an important aspect of culture.


  • Data available on request from the first author.

  • Funding Funding for the first author provided by a K02 award from the Agency for Healthcare Research and Quality (1K02HS017145-02). Funding for the second and fifth authors provided by a R18 award from the Agency for Healthcare Research and Quality (R18-HS019561-01). We have two AHRQ grants that supported efforts by Etchegaray, Gallagher and Thomas.

  • Competing interests None.

  • Ethics approval Approval provided byThe University of Texas Health Science Center at Houston's IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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