title: Error reporting and disclosure systems: views from hospital leaders.
abstract: BACKGROUND
  The Institute of Medicine has recommended establishing mandatory error reporting systems for hospitals and other health settings.
  
  
  OBJECTIVE
  To examine the opinions and experiences of hospital leaders with state reporting systems.
  
  
  METHODS
  Survey of chief executive and chief operating officers (CEOs/COOs) from randomly selected hospitals in 2 states with mandatory reporting and public disclosure, 2 states with mandatory reporting without public disclosure, and 2 states without mandatory systems in 2002-2003.
  
  
  METHODS
  Perceptions of the effects of mandatory systems on error reporting, likelihood of lawsuits, and overall patient safety; attitudes regarding release of incident reports to the public; and likelihood of reporting incidents to the state or to the affected patient based on hypothetical clinical vignettes that varied the type and severity of patient injury.
  
  
  RESULTS
  Responses were received from 203 of 320 hospitals (response rate = 63%). Most CEOs/COOs thought that a mandatory, nonconfidential system would discourage reporting of patient safety incidents to their hospital's own internal reporting system (69%) and encourage lawsuits (79%) while having no effect or a negative effect on patient safety (73%). More than 80% felt that the names of both the hospital and the involved professionals should be kept confidential, although respondents from states with mandatory public disclosure systems were more willing than respondents from the other states to release the hospital name (22% vs 4%-6%, P = .005). Based on the vignettes, more than 90% of hospital leaders said their hospital would report incidents involving serious injury to the state, but far fewer would report moderate or minor injuries, even when the incident was of sufficient consequence that they would tell the affected patient or family.
  
  
  CONCLUSIONS
  Most hospital leaders expressed substantial concerns about the impact of mandatory, nonconfidential reporting systems on hospital internal reporting, lawsuits, and overall patient safety. While hospital leaders generally favor disclosure of patient safety incidents to involved patients, fewer would disclose incidents involving moderate or minor injury to state reporting systems.
authors.affiliation: Institute for Health Policy, Massachusetts General Hospital, Boston 02114, USA. jweissman@partners.org
authors.forename: Joel S
authors.initials: JS
authors.lastname: Weissman
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Annas
authors.forename: Arnold M
authors.initials: AM
authors.lastname: Epstein
authors.forename: Eric C
authors.initials: EC
authors.lastname: Schneider
authors.forename: Brian
authors.initials: B
authors.lastname: Clarridge
authors.forename: Leslie
authors.initials: L
authors.lastname: Kirle
authors.forename: Constantine
authors.initials: C
authors.lastname: Gatsonis
authors.forename: Sandra
authors.initials: S
authors.lastname: Feibelmann
authors.forename: Nancy
authors.initials: N
authors.lastname: Ridley
mesh_terms: D001291:Attitude of Health Personnel; D006291:Health Policy; D006740:Hospital Administrators; D006761:Hospitals / Q000592:standards*; D006801:Humans; D019221:Mandatory Reporting; D019300:Medical Errors; D014481:United States