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Development of the Barriers to Error Disclosure Assessment Tool

Welsh, Darlene PhD, MSN, RN*; Zephyr, Dominique MA; Pfeifle, Andrea L. EdD, PT, FNAP; Carr, Douglas E. MD, MS§; Fink, Joseph L. III JD, BSPharm; Jones, Mandy PharmD, MPAS

doi: 10.1097/PTS.0000000000000331
Original Article: PDF Only

Objectives An interprofessional group of health colleges’ faculty created and piloted the Barriers to Error Disclosure Assessment tool as an instrument to measure barriers to medical error disclosure among health care providers.

Methods A review of the literature guided the creation of items describing influences on the decision to disclose a medical error. Local and national experts in error disclosure used a modified Delphi process to gain consensus on the items included in the pilot. After receiving university institutional review board approval, researchers distributed the tool to a convenience sample of physicians (n = 19), pharmacists (n = 20), and nurses (n = 20) from an academic medical center. Means and SDs were used to describe the sample. Intraclass correlation coefficients were used to examine test-retest correspondence between the continuous items on the scale. Factor analysis with varimax rotation was used to determine factor loadings and examine internal consistency reliability. Cronbach α coefficients were calculated during initial and subsequent administrations to assess test-retest reliability.

Results After omitting 2 items with intraclass correlation coefficient of less than 0.40, intraclass correlation coefficients ranged from 0.43 to 0.70, indicating fair to good test-retest correspondence between the continuous items on the final draft. Factor analysis revealed the following factors during the initial administration: confidence and knowledge barriers, institutional barriers, psychological barriers, and financial concern barriers to medical error disclosure. α Coefficients of 0.85 to 0.93 at time 1 and 0.82 to 0.95 at time 2 supported test-retest reliability.

Conclusions The final version of the 31-item tool can be used to measure perceptions about abilities for disclosing, impressions regarding institutional policies and climate, and specific barriers that inhibit disclosure by health care providers. Preliminary evidence supports the tool’s validity and reliability for measuring disclosure variables.

From the *College of Nursing and †Applied Statistics Laboratory, University of Kentucky, Lexington, KY; ‡Center for Interprofessional Health Education and Practice and §Division of General Surgery, Indiana University School of Medicine, Indianapolis, IN; ∥Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY.

Correspondence: Darlene Welsh, PhD, MSN, RN, College of Nursing, University of Kentucky, 427 College of Nursing Bldg, Lexington, KY 40536 (e-mail:

This pilot project was supported by the National Center for Research Resources at the National Center for Advancing Translational Sciences, National Institutes of Health, through grant UL1TR000117.

The authors disclose no conflict of interest.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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