Elsevier

Surgery

Volume 139, Issue 1, January 2006, Pages 6-14
Surgery

Surgical outcomes research
Error or “act of God”? A study of patients' and operating room team members' perceptions of error definition, reporting, and disclosure

https://doi.org/10.1016/j.surg.2005.07.023Get rights and content

Background

Calls abound for a culture change in health care to improve patient safety. However, effective change cannot proceed without a clear understanding of perceptions and beliefs about error. In this study, we describe and compare operative team members' and patients' perceptions of error, reporting of error, and disclosure of error.

Methods

Thirty-nine interviews of team members (9 surgeons, 9 nurses, 10 anesthesiologists) and patients (11) were conducted at 2 teaching hospitals using 4 scenarios as prompts. Transcribed responses to open questions were analyzed by 2 researchers for recurrent themes using the grounded-theory method. Yes/no answers were compared across groups using chi-square analyses.

Results

Team members and patients agreed on what constitutes an error. Deviation from standards and negative outcome were emphasized as definitive features. Patients and nurse professionals differed significantly in their perception of whether errors should be reported. Nurses were willing to report only events within their disciplinary scope of practice. Although most patients strongly advocated full disclosure of errors (what happened and how), team members preferred to disclose only what happened. When patients did support partial disclosure, their rationales varied from that of team members.

Conclusions

Both operative teams and patients define error in terms of breaking the rules and the concept of “no harm no foul.” These concepts pose challenges for treating errors as system failures. A strong culture of individualism pervades nurses' perception of error reporting, suggesting that interventions are needed to foster collective responsibility and a constructive approach to error identification.

Section snippets

Population and sample

The study population consisted of operating room (OR) team members (general surgeons, nurses, anesthesiologists) and patients from 2 Canadian quaternary care university-affiliated hospitals. The study was reviewed and approved by both hospitals' research ethics boards, and consent was obtained from all study participants.

Homogeneity within each health care discipline was assumed, allowing for a minimum of 5 to 8 participants20 each from the departments of surgery, nursing, and anesthesiology.

Error definition

There were no significant differences among the 4 groups (surgeons, nurses, anesthesiologists, and patients) in their overall frequency of calling an event an error (χ32 = 1.47, P = .83). Across the 4 groups, 97% of the participants deemed the events of scenarios 1 and 2 as errors and 90% perceived the events of scenario 4 as an error. Scenario 3, the dropping and marking of the specimen, was more ambiguous, with only 40% of the participants calling it an error.

The shared perception of what

Discussion

This study yielded new insight into the common justifications used by professionals and patients to explain why they perceive some and not other events as errors. We found both similarities and differences between professionals and patients regarding error, reporting, and disclosure. Together, the data serve to show the distance that remains between current perceptions and a safety-conscious health care culture.

Our first important finding was that surgeons, anesthesiologists, and nurses were

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    Supported through a studentship by the Ontario Student Opportunity Trust Fund—Hospital for Sick Children Foundation Student Scholarship Program (S.E.); the Richard and Elizabeth Currie Chair in Health Professions Education Research (G.R.); and a CIHR New Investigator Award and the BMO Financial Group Professor in Health Professions Education Research (L.L.).

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