Field Placement: UCLA Department of General Internal Medicine
Location: Los Angeles, CA
Preceptor: Neil Wenger, MD
Student Name: Stephanie Fein
Year: 2003

Understanding Norms of Error Disclosure
Focus Group Data Collection
SAFER California Healthcare Pilot Project

Background and Purpose: A significant obstacle to improving patient safety is the lack of disclosure of medical errors by physicians and healthcare providers. Non-disclosure of mistakes hampers the identification and scrutiny of error and the implementation of corrective feedback loops that occur in other highly technical fields. Prior work suggests that both providers and patients believe that medical errors should be identified and discussed, however most errors are not disclosed to patients or to healthcare administrators. Financial and legal disincentives, an expectation of perfection promulgated by medicine, interactions within the physician-patient relationship and a culture that focuses on individual responsibility rather than system improvement promote non-disclosure practices. This project is designed to elucidate the norms of healthcare providers, administrators and patients concerning appropriate disclosure of medical errors. Specifically, this project will characterize the views of patients, attending physicians, residents, nurses and administrators regarding disclosure of medical mistakes at each of the five SAFER California Healthcare sites (UCSF, UCD, UCLA, UCI, UCSD). The resulting report will be presented to the Medical Directors from each of the UC Medical Centers in order to help them formulate the next steps in their effort to promote a more transparent system.

Study Design and Methods: We conducted five focus groups at each of five University of California campuses: one of nurses, one of attending physicians, one of residents, one of recently hospitalized patients and one of hospital administrators. Each group had between 7-12 participants for a total of approximately 250 people. The groups lasted between 75-90 minutes and used a standardized protocol. The focus group discussion broadly explored why medical mistakes occur, whether mistakes are disclosed, factors associated with disclosure, and whether mistakes should be disclosed. Factors and policies that would facilitate disclosure were also considered. Focus group discussions were audiotaped and transcribed. The next step is a qualitative analysis of the data using Atlas ti software. We expect to describe the views of providers, administrators and patients. These findings will inform efforts to develop policy and/or an intervention concerning disclosure.

Internship Accomplishments: I worked with my mentor/preceptor and an administrative assistant to arrange and conduct ten of the twenty-five focus groups, five at UCD and five at UCSF. This involved coordinating schedules, flights, rental cars, food, room arrangements and gift certificates for each group. More importantly it required on-going relationship management with the contact people at each site. Remotely recruiting participants, maintaining morale and moderating focus groups were just a few of the skills I developed and refined this summer.

Back to CHS Field Studies Placement Index | Back to CHS Field Studies | Back to Field Studies Home