The many faces of error disclosure: A common set of elements and a definition

Stephanie P. Fein, Lee H. Hilborne, Eugene M. Spiritus, Gregory B. Seymann, Craig R Keenan, Kaveh G. Shojania, Marjorie Kagawa-Singer, Neil S. Wenger

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

BACKGROUND: Patients want to know when errors happen in their care. Professional associations, ethicists, and patient safety experts endorse disclosure of medical error to patients. Surveys of physicians show that they believe harmful errors should be disclosed to patients, yet errors are often not disclosed. OBJECTIVE: To understand the discrepancy between patients' expectations and physicians' behavior concerning error disclosure. DESIGN, SETTING, AND PARTICIPANTS: We conducted focus groups to determine what constitutes disclosure of medical error. Twenty focus groups, 4 at each of 5 academic centers, included 204 hospital administrators, physicians, residents, and nurses. APPROACH: Qualitative analysis of the focus group transcripts with attention to examples of error disclosure by clinicians and hospital administrators. RESULTS: Clinicians and administrators considered various forms of communication about errors to be error disclosure. Six elements of disclosure identified from focus group transcripts characterized disclosures ranging from Full disclosure (including admission of a mistake, discussion of the error, and a link from the error to harm) to Partial disclosures, which included deferral, misleading statements, and inadequate information to "connect the dots." Descriptions involving nondisclosure of harmful errors were uncommon. CONCLUSIONS: Error disclosure may mean different things to clinicians than it does to patients. The various forms of communication deemed error disclosure by clinicians may explain the discrepancy between error disclosure beliefs and behaviors. We suggest a definition of error disclosure to inform practical policies and interventions.

Original languageEnglish (US)
Pages (from-to)755-761
Number of pages7
JournalJournal of General Internal Medicine
Volume22
Issue number6
DOIs
StatePublished - Jun 2007

Fingerprint

Truth Disclosure
Disclosure
Focus Groups
Hospital Administrators
Medical Errors
Physicians
Communication
Ethicists
Patient Safety
Administrative Personnel
Nurses

Keywords

  • Error disclosure
  • Ethics
  • Medical mistakes
  • Patient/doctor communication

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Fein, S. P., Hilborne, L. H., Spiritus, E. M., Seymann, G. B., Keenan, C. R., Shojania, K. G., ... Wenger, N. S. (2007). The many faces of error disclosure: A common set of elements and a definition. Journal of General Internal Medicine, 22(6), 755-761. https://doi.org/10.1007/s11606-007-0157-9

The many faces of error disclosure : A common set of elements and a definition. / Fein, Stephanie P.; Hilborne, Lee H.; Spiritus, Eugene M.; Seymann, Gregory B.; Keenan, Craig R; Shojania, Kaveh G.; Kagawa-Singer, Marjorie; Wenger, Neil S.

In: Journal of General Internal Medicine, Vol. 22, No. 6, 06.2007, p. 755-761.

Research output: Contribution to journalArticle

Fein, SP, Hilborne, LH, Spiritus, EM, Seymann, GB, Keenan, CR, Shojania, KG, Kagawa-Singer, M & Wenger, NS 2007, 'The many faces of error disclosure: A common set of elements and a definition', Journal of General Internal Medicine, vol. 22, no. 6, pp. 755-761. https://doi.org/10.1007/s11606-007-0157-9
Fein, Stephanie P. ; Hilborne, Lee H. ; Spiritus, Eugene M. ; Seymann, Gregory B. ; Keenan, Craig R ; Shojania, Kaveh G. ; Kagawa-Singer, Marjorie ; Wenger, Neil S. / The many faces of error disclosure : A common set of elements and a definition. In: Journal of General Internal Medicine. 2007 ; Vol. 22, No. 6. pp. 755-761.
@article{35ddd54239b7405283ad6e2f25eeef29,
title = "The many faces of error disclosure: A common set of elements and a definition",
abstract = "BACKGROUND: Patients want to know when errors happen in their care. Professional associations, ethicists, and patient safety experts endorse disclosure of medical error to patients. Surveys of physicians show that they believe harmful errors should be disclosed to patients, yet errors are often not disclosed. OBJECTIVE: To understand the discrepancy between patients' expectations and physicians' behavior concerning error disclosure. DESIGN, SETTING, AND PARTICIPANTS: We conducted focus groups to determine what constitutes disclosure of medical error. Twenty focus groups, 4 at each of 5 academic centers, included 204 hospital administrators, physicians, residents, and nurses. APPROACH: Qualitative analysis of the focus group transcripts with attention to examples of error disclosure by clinicians and hospital administrators. RESULTS: Clinicians and administrators considered various forms of communication about errors to be error disclosure. Six elements of disclosure identified from focus group transcripts characterized disclosures ranging from Full disclosure (including admission of a mistake, discussion of the error, and a link from the error to harm) to Partial disclosures, which included deferral, misleading statements, and inadequate information to {"}connect the dots.{"} Descriptions involving nondisclosure of harmful errors were uncommon. CONCLUSIONS: Error disclosure may mean different things to clinicians than it does to patients. The various forms of communication deemed error disclosure by clinicians may explain the discrepancy between error disclosure beliefs and behaviors. We suggest a definition of error disclosure to inform practical policies and interventions.",
keywords = "Error disclosure, Ethics, Medical mistakes, Patient/doctor communication",
author = "Fein, {Stephanie P.} and Hilborne, {Lee H.} and Spiritus, {Eugene M.} and Seymann, {Gregory B.} and Keenan, {Craig R} and Shojania, {Kaveh G.} and Marjorie Kagawa-Singer and Wenger, {Neil S.}",
year = "2007",
month = "6",
doi = "10.1007/s11606-007-0157-9",
language = "English (US)",
volume = "22",
pages = "755--761",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "6",

}

TY - JOUR

T1 - The many faces of error disclosure

T2 - A common set of elements and a definition

AU - Fein, Stephanie P.

AU - Hilborne, Lee H.

AU - Spiritus, Eugene M.

AU - Seymann, Gregory B.

AU - Keenan, Craig R

AU - Shojania, Kaveh G.

AU - Kagawa-Singer, Marjorie

AU - Wenger, Neil S.

PY - 2007/6

Y1 - 2007/6

N2 - BACKGROUND: Patients want to know when errors happen in their care. Professional associations, ethicists, and patient safety experts endorse disclosure of medical error to patients. Surveys of physicians show that they believe harmful errors should be disclosed to patients, yet errors are often not disclosed. OBJECTIVE: To understand the discrepancy between patients' expectations and physicians' behavior concerning error disclosure. DESIGN, SETTING, AND PARTICIPANTS: We conducted focus groups to determine what constitutes disclosure of medical error. Twenty focus groups, 4 at each of 5 academic centers, included 204 hospital administrators, physicians, residents, and nurses. APPROACH: Qualitative analysis of the focus group transcripts with attention to examples of error disclosure by clinicians and hospital administrators. RESULTS: Clinicians and administrators considered various forms of communication about errors to be error disclosure. Six elements of disclosure identified from focus group transcripts characterized disclosures ranging from Full disclosure (including admission of a mistake, discussion of the error, and a link from the error to harm) to Partial disclosures, which included deferral, misleading statements, and inadequate information to "connect the dots." Descriptions involving nondisclosure of harmful errors were uncommon. CONCLUSIONS: Error disclosure may mean different things to clinicians than it does to patients. The various forms of communication deemed error disclosure by clinicians may explain the discrepancy between error disclosure beliefs and behaviors. We suggest a definition of error disclosure to inform practical policies and interventions.

AB - BACKGROUND: Patients want to know when errors happen in their care. Professional associations, ethicists, and patient safety experts endorse disclosure of medical error to patients. Surveys of physicians show that they believe harmful errors should be disclosed to patients, yet errors are often not disclosed. OBJECTIVE: To understand the discrepancy between patients' expectations and physicians' behavior concerning error disclosure. DESIGN, SETTING, AND PARTICIPANTS: We conducted focus groups to determine what constitutes disclosure of medical error. Twenty focus groups, 4 at each of 5 academic centers, included 204 hospital administrators, physicians, residents, and nurses. APPROACH: Qualitative analysis of the focus group transcripts with attention to examples of error disclosure by clinicians and hospital administrators. RESULTS: Clinicians and administrators considered various forms of communication about errors to be error disclosure. Six elements of disclosure identified from focus group transcripts characterized disclosures ranging from Full disclosure (including admission of a mistake, discussion of the error, and a link from the error to harm) to Partial disclosures, which included deferral, misleading statements, and inadequate information to "connect the dots." Descriptions involving nondisclosure of harmful errors were uncommon. CONCLUSIONS: Error disclosure may mean different things to clinicians than it does to patients. The various forms of communication deemed error disclosure by clinicians may explain the discrepancy between error disclosure beliefs and behaviors. We suggest a definition of error disclosure to inform practical policies and interventions.

KW - Error disclosure

KW - Ethics

KW - Medical mistakes

KW - Patient/doctor communication

UR - http://www.scopus.com/inward/record.url?scp=34248562074&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34248562074&partnerID=8YFLogxK

U2 - 10.1007/s11606-007-0157-9

DO - 10.1007/s11606-007-0157-9

M3 - Article

C2 - 17372787

AN - SCOPUS:34248562074

VL - 22

SP - 755

EP - 761

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 6

ER -