Fear of legal action is the biggest barrier to increased reporting of adverse events, says a coauthor of a new report aimed at reducing medical error. And increased reporting is the key to reducing medical errors that account for 10 000 lives annually in Canada, states the report.
Building a Safer System, released Sept. 26 by the National Steering Committee on Patient Safety, recommends changing evidence acts so that “data and opinions associated with patient-safety and quality-improvement discussions, related documents and reports are protected from disclosure.” (Canada has a federal evidence act for criminal matters and provincial acts for civil matters. They set eligibility and disclosure rules. — Ed.)
A member of the committee, University of Toronto professor Ross Baker, says fear of lawsuits is the “biggest barrier” to change. “People doing their best is not enough. We need a system that allows them to do their best.”
Dr. John Wade, chair of the steering committee, emphasized that “people who have committed a criminal act have to be held accountable,” but less than 1% of adverse events involve criminal negligence.
The report calls for a new National Patient Safety Institute at an initial cost of $10 million annually for 5 years. It would promote changes to enhance reporting, recommend new practices or technologies, and identify necessary research.
The report has been endorsed by 24 national groups, including the CMA and Canadian Medical Protective Association. Dr. Peter Fraser, a CMPA vice-president, says physicians should encourage governments to change evidence acts, which currently “discourage people from fulfilling their professional responsibility.”
The report was written by a steering committee formed during last year's Royal College meeting. The committee's 1-year mandate has ended, but members have formed a working group to ensure the report isn't shelved. Results from a 22-site study of adverse events at Canadian hospitals (CMAJ 2002;167[2]:181) are expected in 2004. — Barbara Sibbald, CMAJ