The authors performed a structured literature review to enhance understanding of factors that both impede and enhance disclosure of medical errors. They performed a MEDLINE search of related articles published between 1975 and 2004, which yielded 5,509 articles. Eight hundred eighty-one were selected for review, including all types of articles, and the factors cited in the articles were analyzed and compared using ANOVA. Of these, 475 articles met all the criteria for inclusion.
The authors conclude that changing the professional ethos surrounding medical errors will be enormously challenging. They suggest that the problem must be tackled by improving motivation to report on three fronts: (1) patient safety (institutional reporting); (2) professional learning (discussion with colleagues); and (3) direct clinical care (informing patients).