Minnesota hospitals went public with their medical mistakes last week, gambling that detailed disclosure will improve care, not sow fear and distrust.
The decision puts Minnesota at the forefront of a debate over how best to educate and empower patients while safeguarding privacy and encouraging healthcare professionals to step forward with mistakes. One tally by the National Academy for State Health Policy shows just five out of 21 states that require hospitals to report errors allow public access to individual hospitals' data.
Minnesota's report, published online by the state Department of Health, shows 30 hospitals reported a total of 99 errors or crimes against patients or employees between July 2003 and early October 2004.
"Making all of this visible is very risky," said Barbara Balik, executive vice president for safety and quality at Allina Hospitals & Clinics, which owns 11 hospitals and reported 16 errors at four hospitals, including two deaths tied to falls and one death linked to low blood sugar.
Public trust may fall and patients' anxiety may rise as a result of revealing medical errors, she said. "We want patients to trust us," she said. Still, Balik said she avidly supports Minnesota's move. Publishing errors builds patients' trust over time by showing the public "we're not hiding," she said.
"We still don't know the full impact that it will have on our patients," she said. Allina readied for questions from consumers by creating public and internal Web pages about the report and updating its employees.
Twenty of the reported errors were linked to deaths and another four to disabilities. The most commonly reported error was an object left inside surgical patients, though none of the 31 cases were connected to death or disability. All four reported cases of misused or malfunctioning devices were tied to deaths, as were all eight reports of patients who fell.
A 2003 bill passed by Minnesota's Legislature requires hospitals to report any of 27 types of serious events tied to disability, death or a threat to patient and worker safety. The state's remaining 115 hospitals reported no medical errors.
By sharing experiences and analyzing data, Minnesota's hospitals hope to improve care, said Bruce Rueben, president of the Minnesota Hospital Association. The association supported the 2003 legislation creating the state's adverse event reporting law, although many hospital officials worried about public backlash. "Everyone's very nervous," Rueben said. "I guess it's full speed ahead."
"It's not a report card," argued Minnesota Health Commissioner Dianne Mandernach. Publishing medical errors should better prepare consumers to ask questions about hospitals' safety efforts, she said, but Mandernach advised patients against using the data to rank hospitals. "It's not pitting one hospital against another. That's not the intention."
Health officials' anxieties don't end with a fear that consumers will use the data to comparison shop. Alison Page, vice president of patient safety for seven-hospital Fairview Health Services, said fear of blame or lawsuits has prevented healthcare providers from disclosing errors. That's changing, she said, as healthcare experts, doctors, nurses and other medical professionals try to shift toward a less punitive culture that encourages disclosure and learning, she said. Fairview reported 22 errors at six hospitals, including two deaths linked to falls and three tied to malfunctioning or misused medical devices.
"It's the public's right to know and it's the right thing to do," Page said. "In Minnesota, we think we're setting the bar a little bit higher on transparency," she said.
An October 2003 National Academy for State Health Policy report described states' disclosure policies as "sporadic and inconsistent."
Mandernach, a former rural hospital executive, said the greatest benefits from Minnesota's effort come from analyzing patterns.
For example, spine operations made up one-third of Minnesota's 13 reported wrong-site surgeries, Page said. Overall, surgical errors accounted for 52 of the state's 99 reported mistakes and were tied to two deaths. A coalition of 17 Twin Cities and Rochester, Minn., hospitals already examining spinal surgery mistakes reviewed the state's collected data and found further evidence of a safety problem, Page said.
Analysis and interviews revealed surgeons could not rely on a common practice-marking the skin near the operative site-to prevent errors, she said. Page and other Minnesota safety experts now recommend surgeons compare X-ray images taken after an initial incision against previous images of the surgical site before proceeding.