Journal of Business Ethics

, Volume 97, Issue 3, pp 491–503 | Cite as

Medical Error Disclosure Training: Evidence for Values-Based Ethical Environments

Article

Abstract

Disclosure of medical and errors to patients has been increasingly mandated in the U.S. and Canada. Thus, some health systems are developing formal disclosure policies. The present study examines how disclosure training may impact staff and the organization. We argue that organizations that support “disclose and apologize” activities, as opposed to “deny and defend,” are demonstrating values-based ethics. Specifically, we hypothesized that when health care clinicians are trained and supported in error disclosure, this may signal a values-based ethical environment, and staff may be more committed to the organization. We surveyed 325 clinical care providers employed by a large hospital that had recently begun implementing disclosure policies and training. Disclosure training explained significant variance in perceptions of the ethical environment, and the ethical environment mediated the relationship between disclosure training and organizational commitment. Although this study explored disclosure of medical errors, organizational support for error disclosure is a concept that could be relevant for many types of organizations.

Keywords

ethical environment values-based ethics error disclosure organizational commitment 

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References

  1. Baron, R.M. and D.A. Kenny: 1986, ‘The Moderator-Mediator Distinction in Social Psychological Research: Conceptual, Strategic, and Statistical Considerations’. Journal of Personality and Social Psychology, 51(6), 1173-1182.CrossRefGoogle Scholar
  2. Beauchamp, T. and J. Childress: 2008, Principles of Biomedical Ethics, 6th ed. (New York, NY: Oxford University Press).Google Scholar
  3. Berlin, L.: 2006, ‘Will saying “I’m sorry” prevent a malpractice lawsuit?’ American Journal of Roentgenology: 187, 10-15.CrossRefGoogle Scholar
  4. Boyte, W. R.: 2001, Casey’s legacy: Finding Generosity When Admitting to an Error in Judgment. Health Affairs, 20(2), 250-254.CrossRefGoogle Scholar
  5. Butcher, L.: 2006, Lawyers Say ‘Sorry’ May Sink You in Court. Physician Executive, 32(2), 20-24.Google Scholar
  6. Chen, D.T. et al.: 2007, Role of Organization Ethics in Critical Care Medicine. Critical Care Medicine, 35(2, suppl.), S11-S17.CrossRefGoogle Scholar
  7. Edmondson, A.C. et al.: 2001, Disrupted Routines: Team Learning and New Technology Implementation in Hospitals. Administrative Science Quarterly, 46, 685-716.CrossRefGoogle Scholar
  8. Frankel, A.S., Leonard, M.W., and Denham, C.R.: 2006, Fair and Just Culture, Team Behavior, and Leadership Engagement: The Tools to Achieve High Reliability. Health Services Research, 41(4), Part II, 1690–1709CrossRefGoogle Scholar
  9. Fritz, J.M. et al.: 1999, Organizational Ethical Standards and Organizational Commitment. Journal of Business Ethics, 20(4), 289-299.CrossRefGoogle Scholar
  10. Gees, E. et al.: 2008, An Evidence-Based Protocol for Nurse Retention. Journal of Nursing Administration, 38(10), 441-447.CrossRefGoogle Scholar
  11. Graber, D.R. and A.O. Kilpatrick: 2008, Establishing Values-Based Leadership and Value Systems in Healthcare Organizations. Journal of Health and Human Services Administration, 31(2): 179-197.Google Scholar
  12. Halbesleben, J.R.B. and C. Rathert: 2008, The Role of Continuous Quality Improvement and Psychological Safety in Workarounds. Health Care Management Review, 33(2), 1-11.Google Scholar
  13. Kern, S.I.: 2009, It’s Still Not Safe to Say I’m Sorry. Medical Economics, 86(1), 40.Google Scholar
  14. Leape, L.: 2005, Ethical issues in patient safety. Thoracic Surgery Clinics, 15, 293-501.CrossRefGoogle Scholar
  15. Martin, K. and Cullen, J.: 2006, Continuities and Extension of Ethical Climate Theory: A Meta-Analytic Review. Journal of Business Ethics, 69, 175-194.CrossRefGoogle Scholar
  16. McDonnell, W.M. and Guenther, E.: 2008., Narrative Review: Do State Laws Make it Easier to Say “I’m Sorry?” Annals of Internal Medicine, 149, 811-815.Google Scholar
  17. Mills, A.E. and E.M. Spencer: 2001. Organization Ethics or Compliance: Which Will Articulate Values for the United States’ Healthcare System? HEC Forum, 13(4), 329-343.CrossRefGoogle Scholar
  18. Mowday, R. et al.: 1970, The Measurement of Organizational Commitment. Journal of Vocational Behavior, 14, 224-247.CrossRefGoogle Scholar
  19. Nembhard, I., and A.E. Edmondson: 2006, Making it Safe: The Effects of Leader Inclusiveness and Professional Status on Psychological Safety and Improvement Efforts in Health Care Teams. Journal of Organizational Behavior, 27, 941-966.CrossRefGoogle Scholar
  20. Nembhard, I.M. et al.: 2009, Why Does the Quality of Health Care Continue to Lag? Insights from Management Research. Academy of Management Perspectives, 23(1): 24-42.Google Scholar
  21. Paine, L.S.: 1994, Managing for Organizational Integrity. Harvard Business Review, 72(2): 106-117.Google Scholar
  22. Pellegrino, E. and D.C. Thomasma: 1988, For the Patient’s Good: The Restoration of Beneficence in Health Care. New York, NY: Oxford University Press.Google Scholar
  23. Proenca, E.J.: 2004, Ethics Orientation as a Mediator of Organizational Integrity in Health Services Organizations. Health Care Management Review, 29(1), 40-50.Google Scholar
  24. Rathert, C. and D.A. Fleming: 2008, Hospital Ethical Climate and Teamwork in Acute Care: The Moderating Role of Continuous Quality Improvement Leadership. Health Care Management Review, 33(4), 323-331.Google Scholar
  25. Rathert, C. et al.: 2009, Improving Work Environments in Health Care: Test of a Theoretical Framework. Health Care Management Review, 34(4), 334-343.Google Scholar
  26. Schneider, B. et al.: 1995. The ASA framework: An update. Personnel Psychology, 48, 747-773.CrossRefGoogle Scholar
  27. Shwu-Ru, L.: 2008, An Analysis of the Concept of Organizational Commitment. Nursing Forum, 43(3), 116-125.CrossRefGoogle Scholar
  28. Silva D.S. et al.: 2008, Clinical Ethicists’ Perspectives on Organisational Ethics in Healthcare Organisations. Journal of Medical Ethics, 34(5), 320-3.CrossRefGoogle Scholar
  29. Silverman, H.J.: 2000, Organizational Ethics in Healthcare: Proactively Managing the Ethical Climate to Ensure Organizational Integrity. HEC Forum, 12(3), 202-215.CrossRefGoogle Scholar
  30. Singer, P.A.: 2000, Medical Ethics: Recent Advances. British Medical Journal, 321, 282-285.CrossRefGoogle Scholar
  31. Treviño, L.K. et al.: 1999, Managing Ethics and Legal Compliance: What works and what hurts. California Management Review, 41(2), 131-151.Google Scholar
  32. Victor, B. and J.B. Cullen: 1988, The Organizational Bases of Ethical Work Climates. Administrative Science Quarterly, 33, 101-125.CrossRefGoogle Scholar
  33. Vinje, H.F. and M.B. Mittlemark: 2007, Job Engagement’s Paradoxical Role in Nurse Burnout. Nursing and Health Sciences, 9, 107-111.CrossRefGoogle Scholar
  34. Waterman, A.D. et al.: 2007, The Emotional Impact of Medical Errors on Practicing Physicians in the United States and Canada. The Joint Commission Journal on Quality and Patient Safety, 33(8), 467-476.Google Scholar
  35. Weaver, G.R. and L.K. Treviño: 1999, Compliance and Values Oriented Ethics Programs: Influences on Employees’ Attitudes and Behavior. Business Ethics Quarterly, 9(2), 315-335.CrossRefGoogle Scholar
  36. Wojcieszak, D. et al.: 2008, Ethics Training Needs to Emphasize Disclosure and Apology. HEC Forum, 20(3), 291-305.CrossRefGoogle Scholar
  37. Wu, A. W.: 2000, Medical error: The second victim. British Medical Journal, 320, 726-727.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.University of MissouriColumbiaU.S.A.

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