Using focus groups to understand physicians' and nurses' perspectives on error reporting in hospitals.

BACKGROUND To increase error reporting, a better understanding of physicians' and nurses' perspectives regarding medical error reporting in hospitals, barriers to reporting, and possible ways to increase reporting is necessary. METHODS Nine focus groups--four with 49 staff nurses, two with 10 nurse managers, and three with 30 physicians--from 20 academic and community hospitals were conducted in May-June 2002 in the St. Louis metropolitan area. Qualitative analysis of focus group transcripts characterized participants' perspectives. RESULTS Although participants knew they should report errors associated with serious adverse events, there was much uncertainty about reporting less serious errors or near misses. Nurses were more knowledgeable than physicians about how to report errors. All groups mentioned barriers to reporting, such as fear of reprisals and lack of confidentiality, time, and feedback after an error is reported. Some physicians doubted the benefit of reporting errors, but, generally, both physicians and nurses agreed that reporting was intended to change practice and policy to promote patient safety. CONCLUSIONS A culture characterized by anonymous reporting, freedom from repercussions, and feedback about error reports should promote error reporting.