Photo Credit Hiring in Healthcare

Actual Comments of Why Employees Leave

“Treatment documentation was altered in order to cover up mistakes. Mistakes were not reported even when known.”

The Solution:

One of the best reasons employees agree to an exit interview is to report safety problems. They feel morally compelled to notify you about issues that they believe, if uncorrected, are going to eventually hurt someone.

Often this is something they feel ethically bound to do in order to protect the safety of their (now-former) co-workers who remain subject to unsafe work conditions or practices.

In this particular case, a healthcare employee is advocating for patient safety by “blowing the whistle” on under-reporting of medical errors and near-misses.

Regardless of the specific requirements of existing federal and state laws, the reporting of medical errors is something institutions are compelled to do ethically.

According to the book “Patient Safety and Quality: An Evidenced-Based Handbook for Nurses” (2008) published by the Agency for Healthcare Research and Quality, “Reporting errors and near misses…provides opportunities to prevent future similar, and perhaps even more serious, errors. Failure to report…is unacceptable because the welfare of patients is at stake.”

Medical mistakes worth reporting can include delays or omissions in the administering of medications, malfunctioning equipment, and myriad human error surrounding anesthesia, diagnoses, tests, surgeries, well, you name it—anything and everything that caused or nearly caused harm to a patient.

According to “Patient Safety and Quality,” two common reasons why errors go unreported include confusion over definitions of what an error is and a simple lack of time to document incidents. The most common reason, however, boils down to fear: fear of being blamed, fear of damaging someone’s reputation or career, fear of legal liability, fear of reprisal (lack of anonymity), and even the altruistic fear that patients will develop negative attitudes or unhealthy anxiety about their ongoing care if they learn about mistakes that were made under the watch of the institution.

Yet patients benefit in the long run from transparency, and so do institutions. According to the book, “If providers cover up errors and mistakes, they do not necessarily stay hidden and often result in compromising the mission of health care organizations.”

A model for health care error disclosure (sharing with patients, significant others, and regulatory agencies) is Veterans Affairs (VA) Medical Center in Lexington, Kentucky. Their policy includes, “reporting details of incidents, expressing institutional regret, and identifying corrective actions.” According to the book, this particular VA hospital’s disclosure policy “resulted in liability payments that were more moderate than such payments at similar facilities.”

Transparency, however, all starts with initial reporting (the providing of initial accounts of possible mistakes to management), and that’s what our exit quote above is about.

To increase error reporting, one school of thought is to eliminate incident reports altogether. That’s because initiating an incident report is intimidating and time-consuming—it takes extra courage and extra time to take this extra, perhaps drama-filled step.

Instead, errors and incidents are documented as a matter of course inside normal, day-to-day reports such as nurse’s notes, patient care rounds, and change-of-shift reports. Errors are then gleaned from these common, everyday reports by administrators or others who take any necessary next steps.

Those next steps would include detailing the error incidents back to all physicians, nurses, pharmacists, lab techs, etc. in regularly-issued reports (daily, weekly or monthly) so mistakes can be learned from and protocols and procedures tweaked as necessary to avoid the repeat of dangerous errors.

Reading regularly published internal reports of errors helps to shape and define for caregivers what does and what does not constitute an “error.” And also makes error reporting more normal, low-profile, and matter of course.

And with some training that reframes medical mistakes away from individual finger-pointing and toward an opportunity for collective improvement, the practice of reporting is de-stigmatized and the “culture of blame” that may be accounting for current under-reporting of medical errors (and apparently “the altering of treatment documentation”) eventually dissipates.

When exiting employees come to us with ethical and safety concerns, acting on them benefits workers—and in this case, patients—in potentially life-saving ways and serves the interest of the organization itself.

(This blog post is brought to you by HSD Metrics, an exit interview company that helps companies reduce employee turnover by providing automated reference checking, exit interviews, and by measuring employee retention. The comments from exiting employees that are featured in this blog are collected from actual exit interviews conducted using ExitRight®, HSD Metrics’ exit interviewing service. If you are interested in learning more, contact us today. Because we place the privacy of our clients at the top of our priority list; the names of all involved parties are kept completely confidential.)