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Antecedents of willingness to report medical treatment errors in health care organizations: A multilevel theoretical framework

Naveh, Eitan; Katz-Navon, Tal

doi: 10.1097/HMR.0b013e3182862869

Background: To avoid errors and improve patient safety and quality of care, health care organizations need to identify the sources of failures and facilitate implementation of corrective actions. Hence, health care organizations try to collect reports and data about errors by investing enormous resources in reporting systems. However, despite health care organizations’ declared goal of increasing the voluntary reporting of errors and although the Patient Safety and Quality Improvement Act of 2005 (S.544, Public Law 109-41) legalizes efforts to secure reporters from specific liabilities, the problem of underreporting of adverse events by staff members remains.

Purpose: The purpose of the paper is to develop a theory-based model and a set of propositions to understand the antecedents of staff members’ willingness to report errors based on a literature synthesis. The model aims to explore a complex system of considerations employees use when deciding whether to report their errors or be silent about them. The model integrates the influences of three types of organizational climates (psychological safety, psychological contracts, and safety climate) and individual perceptions of the applicability of the organization’s procedures and proposes their mutual influence on willingness to report errors and, as a consequence, patient safety.

Practice Implications: The model suggests that managers should try to control and influence both the way employees perceive procedure applicability and organizational context—i.e., psychological safety, no-blame contracts, and safety climate—to increase reporting and improve patient safety.

Eitan Naveh, DSc, is Associate Professor, Faculty of Industrial Engineering and Management, Technion–Israel Institute of Technology, Haifa, Israel. E-mail:

Tal Katz-Navon, PhD, is Senior Lecturer, Arison School of Business, The Interdisciplinary Center (IDC), Herzliya, Israel. E-mail:

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins