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    Accountability in healthcare when adverse events occur

    Jens Hooiveld
    Last modified: 23 August 2021

    Adverse events are an inevitable part of healthcare. Even when healthcare organizations pay strict attention to detail and plan for all likely outcomes, there will always be a percentage of adverse events that are simply unavoidable.

    Unfortunately, it is all too common for these events to be underreported, negatively affecting patient safety. While adverse events often originate with providers, it is the responsibility of healthcare managers to prevent future similar events by spotting and correcting errors when an adverse event occurs. In this article, we will discuss why adverse events and medical errors aren’t reported more often, how healthcare leaders can change that, and how technology can help improve accountability in healthcare.

    Why are medical errors and adverse events underreported?

    Medical errors and adverse events can go unreported for a number of reasons. Creating a culture of accountability and safety within a healthcare organization is crucial to ensuring accurate reporting of adverse events and near-misses from providers and staff. To create the proper culture, however, healthcare leaders need to understand the various reasons for incomplete reporting.

    1. Lack of recognition

    If an adverse event or near-miss goes unreported, does that mean the provider or staff member is intentionally attempting to conceal it? Not necessarily; in some cases, a lack of reporting is simply due to a lack of recognition on the part of the provider or staff member. After all, not all adverse events are medical errors, and some providers view adverse events as an unavoidable part of routine care.

    This lack of clearly-defined parameters could contribute to underreporting. One survey found that nurses were less likely to report unintentional errors than they were serious ones, while another found that nurses were more reticent to report errors that did not result in harm to the patient.

    2. Fear of retribution/consequences

    To effectively address and prevent future adverse events, providers need to feel comfortable reporting errors as they occur—and healthcare managers play a big role in instilling that sense of comfort in providers. Unfortunately, numerous studies and surveys indicate that this often doesn’t happen. In a review of thirty studies (eight from the United States, 22 international), nineteen cited “fear of consequences” as a significant barrier to error reporting.

    The hypothetical consequences that providers fear can vary depending on the individual, but for the majority, they fall into one of the following categories:

    • Being blamed for the error
    • Job loss
    • Legal action
    • Harm to reputation

    If a provider feels that reporting an error, or even acknowledging an adverse event, could have career-altering (or career-ending) consequences, they will be less likely to report adverse events.

    3. Competing pressures

    Within healthcare organizations, there are often competing pressures. Providers need to deliver the best possible quality care while also maximizing the number of patients they see and billable services they provide. Meanwhile, healthcare managers need to maximize profitability, which means ensuring efficient turnover rates, minimizing length of stay, and keeping overhead costs under control. This is on top of prioritizing patient safety.

    These demands are all important, but they can’t all be equally important, and providers must have a clear sense of the organization’s priorities. If they don’t, they can feel like they’re being asked to do too much with too little. And if providers think reporting adverse events will lead to the repercussions mentioned above, they will be less willing to report adverse events. After all, why should they suffer the consequences when the organization has put them in an impossible position?

    >> Learn more about the various reasons in our blog "Barriers to incident reporting in healthcare".

    How leaders can create a culture of accountability

    The solution to underreporting of adverse events is straightforward, but that doesn’t mean it’s easy: Leaders must encourage accountability in healthcare organizations. Creating a culture of accountability will make providers and staff feel comfortable reporting adverse events, near-misses, and errors, and improve patient safety in the process. But how can leaders build this kind of culture?

    1. Get buy-in on vision, strategy, and tactics

    At its core, accountability in healthcare is all about trust. Leaders need to trust that their providers are doing their jobs the right way, and providers need to trust that leaders are there to support the work they do with patients and want everyone to succeed.

    Healthcare leaders can get the ball rolling on creating a culture of accountability by identifying what they want the organization to achieve and how they plan to get there. But to get buy-in from providers and staff, healthcare leaders need to include them in these discussions before rolling out any sweeping changes. By working with providers and staff to hone their vision for accountability and identify the tactics they will use to achieve it, healthcare leaders can earn trust and get buy-in from the providers who will ultimately determine the success or failure of the culture of accountability within an organization.

    2. Invite open communication

    The standard or best practice should be for adverse events to be as rare as possible. But again, some adverse events are simply unavoidable. So when an adverse event does occur, providers and staff should view it as an opportunity to go over what happened and identify what—if anything—they might have done differently to get a different outcome. Even if the answer is “nothing,” taking the time to revisit an adverse event and learn from it will help create and preserve a culture of accountability in healthcare organizations.

    The point of accountability is not to blame or shame providers for adverse events, but to ensure that providers learn from these events when they do occur. Open and honest communication between providers, staff, and healthcare managers is the best way to ensure that everyone within an organization is working together toward a shared goal—patient safety.

    3. Set and communicate clear expectations

    As noted above, a common challenge of event reporting is a lack of clarity around what constitutes an adverse event and what needs to be reported. Without that clarity, it can be difficult to create a culture of accountability in healthcare. Healthcare leaders can remedy this by setting and communicating clear expectations for identifying and reporting adverse events and regularly reminding providers and staff of those expectations.

    Providers and staff will likely need these expectations communicated and reiterated at regular intervals when the new standards are rolled out. However, healthcare leaders also need to avoid over-communicating expectations, which can make providers and staff feel that leadership doesn’t trust their ability to do their jobs.

    4. Foster a sense of ownership and responsibility

    To combat the risk of providers feeling micromanaged, it’s also crucial for healthcare leaders to foster a sense of ownership and responsibility among providers and staff. This goes hand-in-hand with gaining buy-in: Leaders may be the ones rolling out the changes aimed at improving accountability in healthcare, but providers and staff are the ones who will ultimately determine whether or not the changes are successful. And if they feel responsible for the success or failure of the new changes, providers and staff will be more likely to prioritize event reporting—and encourage their colleagues to do the same.

    How can technology improve accountability?

    Creating a culture of accountability in healthcare organizations can be a challenge, and healthcare leaders need all the help they can get. Here’s how technology can help simplify the process and make it easier for leaders to effect real change.

    1. Make adoption easy

    One of the biggest barriers to error reporting is the lack of a simple, easy-to-use reporting system. Providers and staff need to be able to report errors and adverse events as quickly and as easily as possible; after all, they are already extremely busy, and if reporting requires them to be at a specific computer and/or spend 30 minutes painstakingly filling out a lengthy form, they will be more likely to brush it off. Fortunately, technology can help simplify this process.

    Our incident management software allows users to access and complete reporting forms online, either from their computer or mobile device. Forms can also be saved as drafts, so users don’t have to worry about starting the entire process over if something comes up before they can submit their report. With our software, the questions change depending on the type of incident being reported, which means providers, staff, and leaders can focus on the relevant questions.

    2. Increase transparency

    Technology solutions can improve transparency around adverse event reporting, which benefits providers and staff as well as leaders. With the right technology, healthcare leaders can have access to a clearer and more detailed picture of the organization’s overall error reporting practices. More importantly, providers and staff can access concrete, actionable data for use in improving their own reporting. They can even share insights and ideas with their colleagues using software.

    3. Set goals

    Underreporting of adverse events doesn’t happen overnight, but gradually: First, one adverse event or (near) miss goes unreported, then another, then another, and so on. It’s the result of standards slowly slipping over a long period of time—and it will likely take time and patience to bring those standards back up to an acceptable level.

    Technology can help healthcare leaders pinpoint the exact areas where the reporting process is breaking down. By understanding where the problems are, leaders can break down the larger problem into more manageable pieces and set clearer, more tangible goals for providers and staff.

    4. Track progress

    While moving toward a culture of accountability in healthcare organizations, leaders will need to give providers and staff guidance and encouragement along the way, and technology can help them do that. Error reporting and incident management software makes it easier for healthcare leaders to identify what’s improving and what needs work, which in turn allows leaders to be more targeted and specific when communicating their expectations.

    Incident management eBook

    There’s only one thing worse than an adverse event occurring: failing to prevent the next one because nobody knew it was an issue. It’s entirely possible to create a culture of accountability in healthcare organizations—and the right technology solutions make it easier than ever.

    To learn more about the benefits of effective reporting for adverse events and errors, download our eBook on incident management.

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