Coping with medical error: the case of the health professional

Dr Reema Harrison1, Professor Rebecca Lawton2, Professor Gerry Armitage3, Dr Peter Gardner2, Dr Jo Shapiro4, Jessica Perlo5

1 University of Sydney, Australia2 University of Leeds, UK

3 University of Bradford, UK4 Brigham and Women’s Hospital, USA

5 Institute for Healthcare Improvement, USA

School of Public Health | Sydney Medical School

Patient harm from medical care

Adverse events: patient harm from medical care.

Medical errors cause over 50%1.

28% of errors from negligence.

Many unintentional mistakes.

1 Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes B, et al. The nature of adverse events in hospitalized

patients: results of the Harvard Medical Practice Study II. New England journal of medicine 1991; 324(6): 377-384.

Psychological origins of error

Large proportion of errors have psychological

origins

e.g. attentional lapses in highly

routinized procedures

requiring close attention

Tendency to blame

Human tendency to blame others’ mistakes on their personal characteristics (ability, personality, attitudes).

Tendency stronger when the outcome of the mistake is more severe (i.e. greater patient harm).

Would most HP’s in the same situation make the same mistake – situation not person to blame?

Difficult to move away from blame even when we know ‘person-centred’ strategies reduce error rates.

Making an error

Error

Guilt

Shame

Depression

Anxiety

Lose confidence

Incompetent

Systematic

reviews2

demonstrate

consistent effects

of making a

medical error:

2Sirriyeh et al (2010); Seys et al (2012)

Gaps in Knowledge

Lack of large scale studies

Absence of control/comparison

group

Lack of cross-country data– small

scale studies

Limited data on coping strategies

health professionals use

Lack of knowledge about supporting

health professionals who

make errors

Present Study

Cross-sectional survey of

health professionals in

2 academic hospitals in the UK and USA.

WE INVESTIGATED:

• the professional or personal disruption that result from making an error;

• professionals’ emotional responses and the coping strategies they use;

• the relationship between the emotions they experience and the coping strategy that is used;

• perceptions of organisational support.

Sample & settings

› UK: 1 large teaching hospital Trust in northern England

› USA: 1 large academic hospital in Boston, MA

› Doctors and nurses at level of seniority in any department/ward

› Recruitment via:

• Organisational newsletters

• E-mail distribution lists

• Organisational intranet

• Paper copies in training sessions/wards.

Method

Survey tool created and validated in

the UK

Ethics approval obtained

each hospital.

Study invitations &

survey distributed

265 respondents: 120 doctors; 145 nurses

Data analysis - SPSS & framework analysis

HPEEQ Survey Tool

5 components:

• Demographic information

• Error characteristics – severity, time since

• Emotional responses (PANAS)

• Coping strategies (FDCS)

• Free text items - org. support

Findings

Professional and personal disruption prevalent - negative

emotions common

Positive feelings of determination, attentiveness and alertness.

Emotional response and coping strategy selection did not differ between countries or level of pt

harm

Nurses in both locations reported stronger negative feelings.

Findings cont.

Problem-focused coping strategies favoured.

Associations between coping strategy used and particular

emotional responses.

Peers were most valued support.

Fears over confidentiality prohibit staff from accessing formal org.

support.

What does this mean for nurses?

› Making a medical error = detrimental to health professionals’ well-being

& safe patient care.

› Nurses particularly vulnerable - greater exposure to punitive action -

may require additional support.

› Building psychological resilience - an individual's ability to adapt to

stress and adversity; to be positive, optimistic & to learn from mistakes.

› Not everyone is equally resilient – importance of being part of a team/

being able to access social support.

› Peers support - promote psychological resilience & protect patients.

Thank you!

Email: reema.harrison@sydney.edu.au

School of Public Health | Sydney Medical School