For more than a decade, patient safety leaders have urged medicine to shift from an approach that shames and blames individual doctors and nurses for medical errors to a "culture of safety" where open discussion and reporting about adverse events, mistakes, disruptive behavior and unsafe conditions are prized rather than punished.
This less-punitive model of medical-error prevention, inspired by the aviation industry's safety record since the 1980s, is a key element of the Joint Commission requirements hospitals must follow to get paid by Medicare. And a growing body of evidence is showing that higher safety culture scores are correlated with better clinical outcomes and lower rates of hospital-acquired conditions.
Yet data released in February by the Agency for Healthcare Research and Quality show that most physicians, nurses, pharmacists and other health professionals working in hospitals believe their organizations are still more interested in punishing missteps and enforcing hierarchy than in encouraging open communication and using adverse-event reports to learn what's gone wrong.
Half of the nearly 600,000 staffers surveyed at more than 1,110 hospitals nationwide said they believe their mistakes are held against them, and 54% said that when an adverse event is reported, "it feels like the person is being written up, not the problem."
Nearly two-thirds said they worry that mistakes are being held in their personnel file. A little less than half of respondents said they "feel free to question the decisions or actions of those with more authority
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