title: An empirically derived taxonomy of factors affecting physicians' willingness to disclose medical errors.
abstract: BACKGROUND
  Physician disclosure of medical errors to institutions, patients, and colleagues is important for patient safety, patient care, and professional education. However, the variables that may facilitate or impede disclosure are diverse and lack conceptual organization.
  
  
  OBJECTIVE
  To develop an empirically derived, comprehensive taxonomy of factors that affects voluntary disclosure of errors by physicians.
  
  
  METHODS
  A mixed-methods study using qualitative data collection (structured literature search and exploratory focus groups), quantitative data transformation (sorting and hierarchical cluster analysis), and validation procedures (confirmatory focus groups and expert review).
  
  
  RESULTS
  Full-text review of 316 articles identified 91 impeding or facilitating factors affecting physicians' willingness to disclose errors. Exploratory focus groups identified an additional 27 factors. Sorting and hierarchical cluster analysis organized factors into 8 domains. Confirmatory focus groups and expert review relocated 6 factors, removed 2 factors, and modified 4 domain names. The final taxonomy contained 4 domains of facilitating factors (responsibility to patient, responsibility to self, responsibility to profession, responsibility to community), and 4 domains of impeding factors (attitudinal barriers, uncertainties, helplessness, fears and anxieties).
  
  
  CONCLUSIONS
  A taxonomy of facilitating and impeding factors provides a conceptual framework for a complex field of variables that affects physicians' willingness to disclose errors to institutions, patients, and colleagues. This taxonomy can be used to guide the design of studies to measure the impact of different factors on disclosure, to assist in the design of error-reporting systems, and to inform educational interventions to promote the disclosure of errors to patients.
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA. lauris-kaldjian@uiowa.edu
authors.forename: Lauris C
authors.initials: LC
authors.lastname: Kaldjian
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Jones
authors.forename: Gary E
authors.initials: GE
authors.lastname: Rosenthal
authors.forename: Toni
authors.initials: T
authors.lastname: Tripp-Reimer
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Hillis
mesh_terms: D001291:Attitude of Health Personnel; D016000:Cluster Analysis; D004992:Ethics, Medical; D017144:Focus Groups; D006801:Humans; D019300:Medical Errors / Q000941:ethics / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research; D012941:Social Responsibility; D014342:Truth Disclosure; D014481:United States