Letters to the Editor
To the Editor:
In the June 2011 issue of Academic Medicine, Scott et al1 presented an innovative method of increasing adverse event reporting. Whilst this approach has increased error-reporting rates, it raises real methodological issues. For example, the transferability and sustainability of their approach are limitations (which the authors acknowledge).
Another problem involves an omission from the authors' research. The systems approach views error as a result of system failure, with the remedy being to address the underlying problems within the system.2 The underlying system problem in many hospitals is the culture. It is well understood that the establishment of a safety culture requires significant support from all levels of the organizational hierarchy. Scott and colleagues' approach should be commended for focusing on residents, who are at the cold face of interactions between patients. However, they are arguably the bottom of the ladder in the hospital setting. It has been demonstrated that perceptions of senior managers' attitudes and behaviors in relation to the safety and well-being of the workforce will form the basis of the safety behaviors of workers and, therefore, the safety performance of the organization.3 Yet the authors did not study the senior managers' attitudes and behaviors, a glaring gap in their research.
Another issue is that the literature suggests that there is a paucity of evidence for the effectiveness of error-reporting systems4 and that incident reporting should probably be used as one of a number of methods to detect and learn from errors.5 Yet incident reporting is the only method the authors employed in their research.
I believe the real issues have not been addressed by Scott et al. I recommend that future research should focus on the introduction of a portfolio of systems for error reporting and management that are integrated in a systematic way.5 In addition, senior staff, including hospital management, need to be key stakeholders in the development of a safety culture. These two approaches are likely to be important means of effecting system changes and assisting in the reduction of medical errors and adverse events.
Amber Kelaart, MHlthServMt
Senior dietitian, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; firstname.lastname@example.org.
1. Scott DR, Weimer M, English C, et al.. A novel approach to increase residents' involvement in reporting adverse events. Acad Med. 2011;86:742–746.
2. McNeil JJ, Ogden K, Briganti E, Ibrahim JE, Loff B, Majoor JW. Chapter 2: Literature review. In: Improving Patient Safety in Victorian Hospitals. Melbourne, Victoria, Australia: Department of Human Services; 2000:5–21.
3. Clarke S. Perceptions of organizational safety: Implications for the development of safety culture. J Organ Behav. 1999;20:185–198.
4. Woodward HI, Mytton OT, Lemer C, et al.. What have we learned about interventions to reduce medical errors? Annu Rev Public Health. 2010;31:479–497.
5. Olsen S, Neale G, Schwab K, et al.. Hospital staff should use more than one method to detect adverse events and potential adverse events: Incident reporting pharmacist surveillance and local real-time record review may have a place. Qual Saf Health Care. 2007;16:40–44.