Physicians' perception of and attitudes towards patient safety culture and medical error reporting

환자안전 문화와 의료과오 보고에 대한 의사의 인식과 태도

  • Published : 2005.12.01


The objectives of this study were (1) to describe doctors' perception and attitudes toward patient safety culture and medical error reporting in their working unit and hospitals, (2) to examine whether these perception and attitudes differ by doctors' characteristics, such as sex, position, and specialties, and (3) to understand the relationship between overall perception of patient safety in their working unit and each sub domain of patient safety culture. A survey was conducted with 135 doctors working in a university hospital in Korea. After descriptive analyses and chi-square tests of subgroup differences, a multivariate-regression of overall perception of patient safety in their unit with sub-domains of patient safety culture was conducted. Overall, a significant proportion of doctors expressed negative perception of their working units' patient safety culture, many reporting potentials for patient safety problems to occur in their unit. They also negatively viewed their hospital leadership's commitment on patient safety. Regarding the patient safety in their working unit, doctors were most worried about staffing level and observance of safety procedures. Most doctors did not know how and which medical error to report. They also perceived that medical errors would work against them personally and penalize them. About 22 percent of respondents believed that even seriously harmful medical errors were not reported.


Medical errors;Patient safety;Organizational culture;Error reporting


  1. 김이경. Analysis of Inpatient adverse drug events (ADEs) with retrospective review of electronic medical records using ADE signals [석사 학위논문]. 서울: 숙명여자대학교; 2004.
  2. 김혜영. Analysis of hospital admission sue to adverse drug reaction (ADEs) using ADE signals [석사 학위논문]. 서울: 숙명여자대학교, 2004.
  3. 사법연감 (2003). Accessed July 15, 2004
  4. Aron DC, Headrick LA. Educating physicians prepared to improve care and safety is no accident: it requires a systematic approach. Qual Saf Health Care 2002; 11: 168-173
  5. Barach P, Small S. Reporting and preventing medical mishaps: lessons from non-medical near miss reporting. Br Med J 2000; 320: 759-763
  6. Bates DW, Leape L, Cullen DJ, Laird N. Petersen, LA, et al.. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998; 280: 1311-1316
  7. Brennan T, Leape L, Laird N. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study. N Eng J med 1991; 324: 370-6
  8. Chaudhry SI, Olofinboba KA, Knnnholz HM, Detections of errors by attending physicians on a general medicine service. J Gen Intern Men 2003; 18: 595-600
  9. Davies HTO, Nutley SM, Mannion R. Organizational culture and quality of health care. Qual health Care 2000; 9: 111-119
  10. Department of Health. An Organization with a Memory. London: The Stationery Office, 2000
  11. Department of Health. Building a Safer NHS for Patients. London: The Stationery Office, 2001
  12. Donaldson LJ, Gray JA. Clinical governance: a quality duty for health organizations. Qual Health Care 1998; 7(suppl): 537-44
  13. Firth-Cozen J, Mowbray D. Leadership and the quality of care. Quality in Health Care 2001; 10(suppl II): ii3-ii7
  14. Hudelson, PM. Culture and quality: an anthropological perspective. BMJ 2004; 6(5): 345-346
  15. Hudson P. Applying the lessons of high risk industries to health care. Qual Saf Health Care 2003; 12: i7
  16. Edwards N. Doctors and managers: poor relationships may be damaging patients - what can be done? Qual Saf Health Care 2003; 12:i21
  17. Hyde P, Davies HTO. Service design, culture and performance: Collusion and co-production in health care. Human Relations 2004; 57(11): 1407-1426
  18. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC National Academy Press; 2001
  19. Institute of Medicine. To err is human: building a safer health system. Washington, DC National Academies Press; 1999
  20. Kizer, KW. Patient safety: A call to action. A consensus statement from the National Quality Forum. MedScape Gen Med. Mar 21, 2001. Website:
  21. Kizer, W. The Emerging Imperative for health care quality improvement. Acad Emerg Med 2002; 9(11): 1078-1084
  22. Koeck, C. Time for organizational development in healthcare organization. Improving quality for patients means changing the organization (editorial). BMJ 1998; 317: 1267-8
  23. Lawton R, Parker D. Barriers to incident reporting in a health care system. Qual Safety Health Care 2002; 11: 15-18
  24. Leap LL, Error in Medicine. JAMA 1994; 272: 1851-7
  25. Meterko M. Teamwork Culture and Patient Satisfaction in Hospitals. Medical Care 2004; 42 : 492-7
  26. Moss F, Garside P, Dawson P. Organizational change: the key to quality improvement. Quality in Health Care 1998; 7(suppl): S1-2
  27. National Patient Safety Agency (NPSA)/Department of Health. Doing Less Harm London: NPSA, 2001
  28. NPSA Seven Steps to Patient Safety. London: NPSA, 2003
  29. O'Neil A, Petersen M, Cook E, Bates D, Thomas H, Brennan T. Physician reporting compared with medical-record review to identify adverse medical events. Ann Intern Med 1993; 119: 370-376
  30. Poon, EG, Blumenthal D, Jaggi T, Honour MM, Bates DW, Kaushal R. Overcoming Barriers To Adopting And Implementing Computerized Physician Order Entry Systems In U.S. Hospitals. Health Affairs 2004; 23(4): 184-190
  31. Pronovost PJ, Weast B, Holzmueller CG, Rosestein BJ, Kidwell RP, Haller KB, Feroli ER, Sexton JB, Rubin HR. Evaluation of the culture of safety: survey of clinicians and managers in an academic medical center. Qual Saf Health Care 2003; 12: 405-410
  32. Reason J. Managing the Risks of Organizational Accidents. Aldershot' Ashgate; 1997
  33. Reason, J. Human error: models and management. BMJ 2000; 320: 768-70
  34. Sexton JB, Thomas EJ, Helmreich RL. Error, Stress, and Teamwork in Medicine and Aviation: Cross Sectional Surveys. BMJ 2000; 320: 745-749
  35. Singer SJ, Gaba DM, Geppert JJ, Sinaiko AD, Howard SK, Park KC. The culture of safety: results of an organization-wide survey in 15 California hospitals. Qual Saf Health Care 2003; 12: 112-118
  36. Stephenson, J. CDC campaign targets anti-microbial resistance in hospitals. JAMA 2002; 287: 2351-2
  37. Thomas EJ, Sexton JB, Helmreich RL. Discrepant attitudes about teamwork among critical care nurses and physicians. Crit Care Med 2003; 31(3): 956-959
  38. Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ 2001; 322:517-9
  39. Vincent C, Stanhope N, Crowley-Murphy M. Reasons for not reporting adverse incidents: an empirical study. J Eval Clin Pract 1999; 5: 13-21
  40. Waring JJ, A qualitative study of the intra-hospital variations in incident reporting, Int J Qual Health Care 2004; 16: 347-352
  41. Weeks WB and Bagian JP Developing a Cultura of Safety in the Veterans Health Administration. Eff Clin Pract 2000;6;270-276
  42. Wolff A, Bourke J. Reducing medical error: a practical guide. Med J Aus 2000; 173: 247-251
  43. Wu AW, Folkman S, Mcphee SJ, La B. Do house officers learn from their mistakes? Qual Saf Health Care 2003;12:221-228
  44. Blendon RJ, DesRoches CM, Brodie M, Benson J, Rosen A, Schneider E, Altman D, Zapert K, Herman M, Steffenson A. Views of practicing physicians and the public on medical errors. N Engl J Med 2002; 347: 1933-1940
  45. Nieva VF, Sorra J. Safety culture assessment: a tool for improving patient safety in healthcare organizations. Qual Saf Health Care 2003; 12: 17-23
  46. Hemreich RL. On error Management: lessons from aviation. BMJ 2000; 320:781-5
  47. Thomas, EJ, Studdert DM, Newhouse JP, Zbar BIW, Howard KM, Williams EJ, Cost of medical injuries in Utah and Colorado. Inquiry 1999; 36: 255-64
  48. Walshe K, T Freeman. Effectiveness of quality improvement: learning from evaluations. Qual Saf Health Care. 2002;11:85-87

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