BACKGROUND: Physician disclosure of medical errors to institutions, patients, and colleagues is important for patient safety, patient
care, and professional education. However, the variables that may facilitate or impede disclosure are diverse and lack conceptual
organization.
OBJECTIVE: To develop an empirically derived, comprehensive taxonomy of factors that affects voluntary disclosure of errors by physicians.
DESIGN: A mixed-methods study using qualitative data collection (structured literature search and exploratory focus groups), quantitative
data transformation (sorting and hierarchical cluster analysis), and validation procedures (confirmatory focus groups and
expert review).
RESULTS: Full-text review of 316 articles identified 91 impeding or facilitating factors affecting physicians’ willingness to disclose
errors. Exploratory focus groups identified an additional 27 factors. Sorting and hierarchical cluster analysis organized
factors into 8 domains. Confirmatory focus groups and expert review relocated 6 factors, removed 2 factors, and modified 4
domain names. The final taxonomy contained 4 domains of facilitating factors (responsibility to patient, responsibility to
self, responsibility to profession, responsibility to community), and 4 domains of impeding factors (attitudinal barriers,
uncertainties, helplessness, fears and anxieties).
CONCLUSIONS: A taxonomy of facilitating and impeding factors provides a conceptual framework for a complex field of variables that affects
physicians’ willingness to disclose errors to institutions, patients, and colleagues. This taxonomy can be used to guide the
design of studies to measure the impact of different factors on disclosure, to assist in the design of error-reporting systems,
and to inform educational interventions to promote the disclosure of errors to patients.
Key Words medical errors - error reporting - patient safety - disclosure - medical ethics
None of the authors have any conflicts of interest to declare.
Some of the data from this study were presented at the Society of General Internal Medicine’s 27th Annual Meeting, Chicago,
May 15, 2004 and have been published as an abstract (J Gen Intern Med. 2004;19(S1):177).
Dr. Kaldjian is supported by funding from the Robert Wood Johnson Foundation’s Generalist Physician Faculty Scholars Program
(grant # 45446).
The views expressed in this article are those of the authors and do not necessarily represent the views of the Department
of Veterans Affairs.