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Many Hospital Execs Oppose Mandatory Error Reporting

Most think it won't help patients but will encourage lawsuits, survey finds

TUESDAY, March 15, 2005 (HealthDay News) -- A new survey of hundreds of executives running hospitals in six states finds a majority object to state laws requiring hospitals to report major and minor medical errors.

Many expressed concerns that these regulations will actually inhibit full disclosure due to doctors' and administrators' fears of litigation as errors are made public.

However, the survey of executives from 203 hospitals also found that those in states with mandatory reporting laws already in place were less likely to voice strong objections to these rules, compared to executives in states without such laws on the books.

"It seems that there's a resistance to change [among executives] but that familiarity with these laws breeds acceptance," said lead researcher Joel S. Weissman, a professor of medicine in the department of health care policy at Harvard Medical School.

"Obviously, the U.S. system is in flux," he said.

His team reported the findings in the March 16 issue of the Journal of the American Medical Association.

According to the National Academy for State Health Policy, 21 states now require some form of mandatory reporting of medical errors. In some states, all information about the specific incident is kept confidential, while in other states information such as the name of the hospital where the error occurred may be made available to the public. All states keep patient identities confidential.

These types of regulations "have a dual goal," Weissman said.

"One of them is public accountability -- the public's right to know what's going on," he explained, while the other is to improve public safety by spotting areas of weakness that may need improvement, he said.

But how eager are hospital administrators to embrace mandatory reporting? In their 2002-2003 study, Weissman's team conducted frank, confidential interviews with chief executive officers, chief operating officers, and chief financial officers from 203 hospitals in six states. Those states included Massachusetts and Colorado (which have mandatory reporting laws that allow for the disclosure of certain information to the public); Pennsylvania and Florida (which have mandatory, but confidential, reporting policies in place); and Georgia and Texas (which had no mandatory reporting laws in place at the time of the survey).

By and large, "the hospital executives we interviewed had some pretty substantial reservations about mandatory reporting systems that make information public," Weissman said. "They felt it led to more lawsuits and had a chilling effect on their own hospital's reporting systems. They also didn't see a lot of value to overall patient safety in their [respective] states."

Specifically, 79 percent of executives surveyed thought non-confidential, mandatory reporting would encourage lawsuits, 69 percent thought it would discourage internal reporting, and 73 percent thought it would end up having either no effect -- or even a negative effect -- on patient safety.

However, studies suggest many of those fears may be groundless, Weissman said.

He said that in terms of lawsuits, for example, studies from researchers at both the University of Michigan Health System and the Veterans Administration health system have found that increased openness about medical errors has actually saved hospitals money and legal hassles.

After the introduction of mandatory reporting, "the number of [error] cases that were talked about went up" at these institutions, Weissman said, "but the number that actually went to lawsuits, and the total hospitals had to pay out to lawyers, went down."

That finding might help explain a second, intriguing finding from the survey: Executives running hospitals in states where mandatory reporting was already firmly established were less opposed to this type of legislation than administrators in states without these laws.

According to Weissman, that may mean that initial fears about litigation subside as the expected avalanche of lawsuits fails to materialize.

Leslie Kirle is senior director for clinical policy and patient advocacy at the Massachusetts Hospital Association, and helped represent the industry as a co-researcher on the study.

She believes mandatory reporting can help improve patient safety. But she also believes there's room for improvement in the current system.

"Things such as making sure the definitions are clear in terms of what needs to be reported and, most importantly, getting that information back to hospitals for improvement purposes," Kirle said. "That's certainly a big goal that we all have, so that we can learn from these issues."

Weissman agreed. "Without mentioning any states by name, we know they collect data and they haven't analyzed it yet, other than in a case-by-case fashion," he said. Case-by-case analysis "has some value for the hospital itself. But let's say you're in hospital X and you find there was a problem with a blood transfusion and you discover some underlying cause -- that information isn't getting out to any other hospitals."

"We need to do more about collecting data and analyzing it in a systematic way to find out what's going on across the system," Weissman said.

He said the unprecedented cooperation between researchers, state regulators and hospital executives involved in this study bodes well for that effort, however.

More information

For more in this issue, go to the National Academy for State Health Policy.

SOURCES: Joel S. Weissman, Ph.D., associate professor, medicine, department of health care policy, Harvard Medical School, Boston; Leslie Kirle, M.P.H., senior director, clinical policy and patient advocacy, Massachusetts Hospital Association; March 16, 2005, Journal of the American Medical Association
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