Date of Award

11-9-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Grace Jenq

Second Advisor

Julie Rosenbaum

Third Advisor

Lloyd Cantley

Abstract

Despite significant efforts among health care leaders in the past two decades to move away from the so-called culture of blame, individual blame for medical errors is still a significant presence in health care settings. Furthermore, little is understood about how individual people assign blame, and what differences, if any, exist between different health care professionals in how they assign individual blame. The study tested three hypotheses regarding the allocation of blame for medical errors. Hypothesis #1: Despite a shift towards systems-based thinking, health care professionals will blame individuals rather than the system for medical errors. Hypothesis #2: Even when given the exact same information, health care professionals will allocate blame or accountability for medical errors differently depending on their role in the health care system. Hypothesis #3: In general, health care professionals will allocate blame disproportionately towards other professions rather than blame their own professions. We conducted a detailed survey centered on a set of three standardized cases, each involving fictitious clinical vignettes during a single patient admission. Each case involved multiple medical errors, each of which was necessary but insufficient in isolation to result in the adverse outcome. After each case respondents allocated blame for the medical errors among four root causes that corresponded to nurses, physicians, and hospital administrators. A self blame ratio was calculated which examined the extent to which people disproportionately assigned blame to their own profession compared to the level of blame assigned them by other respondents. Overall, when given specific cases, respondents placed more blame on individuals than on systemic factors. Respondents placed more blame on physicians than on nurses, and hospital administrators placed more blame on the system and culture (non-individual factors) than either physicians or nurses placed on these factors. Respondents role within the health care system was of significant predictive value in determining how they would assign blame for standardized cases. ANOVA of the mean values of blame allocation across all three cases demonstrated statistically significant differences by respondents position for blame allocation to nurses (p =.004) and blame allocation to hospital system (p =.017) but not for blame allocation to physicians or blame allocated to hospital culture (p =.256 and p =.333, respectively). Self-blame scores averaged above 1.00 (1.20±.50, N=85), indicating that respondents in general placed more blame on their own professions than others placed on them. This held true across all three groups, but was the most pronounced with nurses (1.40±.48, N=24), moderately pronounced with administrators (1.09±.34, N=38), and the least pronounced with physicians (1.17±.67, N=23). ANOVA of differences between groups was statistically significant (p =.049). Conclusions: Respondents placed more blame on individuals than non-individuals; role within the hospital was a significant predictor of blame allocation; and respondents overall tended to blame their own professions more than others blamed them.

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