Cited by 1,069Patient Safety and Medication ErrorsHospital Admissions and OutcomesClinical Reasoning and Diagnostic Skills

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Communication Failures: An Insidious Contributor to Medical Mishaps

Sutcliffe, Kathleen M., Lewton, Elizabeth, Rosenthal, Marilynn M.·2004·Academic Medicine

DOI 10.1097/00001888-200402000-00019

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Abstract

PURPOSE: To describe how communication failures contribute to many medical mishaps. METHOD: In late 1999, a sample of 26 residents stratified by medical specialty, year of residency, and gender was randomly selected from a population of 85 residents at a 600-bed U.S. teaching hospital. The study design involved semistructured face-to-face interviews with the residents about their routine work environments and activities, the medical mishaps in which they recently had been involved, and a description of both the individual and organizational contributory factors. The themes reported here emerged from inductive analyses of the data. RESULTS: Residents reported a total of 70 mishap incidents. Aspects of "communication" and "patient management" were the two most commonly cited contributing factors. Residents described themselves as embedded in a complex network of relationships, playing a pivotal role in patient management vis-à-vis other medical staff and health care providers from within the hospital and from the community. Recurring patterns of communication difficulties occur within these relationships and appear to be associated with the occurrence of medical mishaps. CONCLUSION: The occurrence of everyday medical mishaps in this study is associated with faulty communication; but, poor communication is not simply the result of poor transmission or exchange of information. Communication failures are far more complex and relate to hierarchical differences, concerns with upward influence, conflicting roles and role ambiguity, and interpersonal power and conflict. A clearer understanding of these dynamics highlights possibilities for appropriate interventions in medical education and in health care organizations aimed at improving patient safety.

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Authors: Sutcliffe, K. M., Lewton, E., & Rosenthal, M. M.
Affiliations: University of Michigan (US)
Corresponding author: Sutcliffe, Kathleen M.
Venue: Academic Medicine
Publisher: Oxford University Press (OUP)
Published: 2004-02
Volume: 79
Issue: 2
Pages: 186-194
ISSN: 1040-2446 (ISSN-L)
DOI: 10.1097/00001888-200402000-00019
OpenAlex: W2033026182
Cited by: 1,069
References: 14
Citations by year: 2026: 43 · 2025: 35 · 2024: 31 · 2023: 39 · 2022: 35 · 2021: 61 · 2020: 55 · 2019: 55 · 2018: 57 · 2017: 61 · 2016: 74 · 2015: 66 · 2014: 67 · 2013: 72 · 2012: 58
FWCI: 32.77
Type: journal article
Language: en
Open access: closed
Locations: Academic Medicine (publishedVersion)
PubMed (publishedVersion)
Deep Blue (University of Michigan) (submittedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
Health Sciences › Nursing › Leadership and Management › Hospital Admissions and Outcomes
Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Keywords: communication breakdown, medical errors, patient safety, medical residents, clinical management, organizational factors, role ambiguity, health care organization, medical education
MeSH terms: Adult, Clinical Competence, Communication, Female, Hospitals, Teaching, Humans, Internship and Residency, Interprofessional Relations, Interviews as Topic, Male, Patient Care Management, Physician-Patient Relations, Physician's Role, Random Allocation, Sampling Studies, United States, Medical Errors

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Communication Failures: An Insidious Contributor to Medical Mishaps

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