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.
- Review of the articles identified 35 factors believed to facilitate error disclosure and 41 believed to impede disclosure.
- Accountability is the most commonly cited reason for disclosure, and fear of professional repercussions the most commonly cited impediment to disclosure.
- Relationships with patients are motivating factors in facilitating disclosure; removed realms where patient safety and professional learning are motivations (i.e., a future gain is anticipated) seem to inspire less motivation to disclose.
- Assertions that increased disclosure may decrease liability costs and should be thoroughly analyzed; transparency does not necessarily lead to fewer lawsuits and may actually increase them.
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).