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Cited by 27Clinical Reasoning and Diagnostic SkillsPatient Safety and Medication ErrorsHospital Admissions and Outcomes

Pediatric Clinician Comfort Discussing Diagnostic Errors for Improving Patient Safety: A Survey

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Grubenhoff, Joseph A., Ziniel, Sonja I., Cifra, Christina L., Singhal, Geeta, McClead, Richard E., Singh, Hardeep·2020·Pediatric Quality & Safety
DOI 10.1097/pq9.0000000000000259PMC PMC7190246
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Abstract

Introduction: Meaningful conversations about diagnostic errors require safety cultures where clinicians are comfortable discussing errors openly. However, clinician comfort discussing diagnostic errors publicly and barriers to these discussions remain unexplored. We compared clinicians’ comfort discussing diagnostic errors to other medical errors and identified barriers to open discussion. Methods: Pediatric clinicians at 4 hospitals were surveyed between May and June 2018. The survey assessed respondents’ comfort discussing medical errors (with varying degrees of system versus individual clinician responsibility) during morbidity and mortality conferences and privately with peers. Respondents reported the most significant barriers to discussing diagnostic errors publicly. Poststratification weighting accounted for nonresponse bias; the Benjamini–Hochberg adjustment was applied to control for false discovery (significance set at P< 0.018). Results: Clinicians (n = 838; response rate 22.6%) were significantly less comfortable discussing all error types during morbidity and mortality conferences than privately (P< 0.004) and significantly less comfortable discussing diagnostic errors compared with other medical errors (P< 0.018). Comfort did not differ by clinician type or years in practice; clinicians at one institution were significantly less comfortable discussing diagnostic errors compared with peers at other institutions. The most frequently cited barriers to discussing diagnostic errors publicly included feeling like a bad clinician, loss of reputation, and peer judgment of knowledge base and decision-making. Conclusions: Clinicians are more uncomfortable discussing diagnostic errors than other types of medical errors. The most frequent barriers involve the public perception of clinical performance. Addressing this aspect of safety culture may improve clinician participation in efforts to reduce harm from diagnostic errors.

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  • Pressure from social norms and shaming can inhibit clinicians from reporting or discussing clinical errors, as it may result in judgments about their competency and damage their reputation.

    “Pressure from social norms and shaming can inhibit clinicians from reporting or discussing clinical errors, as it may result in judgments about their competency and damage their reputation [32,253].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [32]

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Authors
Grubenhoff, J. A., Ziniel, S. I., Cifra, C. L., Singhal, G., McClead, R. E., & Singh, H.
Affiliations
  • University of Colorado Anschutz (US)
  • University of Iowa (US)
  • Baylor College of Medicine (US)
  • The Ohio State University (US)
  • Michael E. DeBakey VA Medical Center (US)
Corresponding author
  • Grubenhoff, Joseph A.
  • Ziniel, Sonja I.
ORCID
Venue
Pediatric Quality & Safety
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2020-02-27
Volume
5
Issue
2
Pages
e259
ISSN
2472-0054 (ISSN-L)
DOI
10.1097/pq9.0000000000000259
PMC
PMC7190246
OpenAlex
W3010189701
Cited by
27
References
50
Citations by year
2026: 4 · 2025: 2 · 2024: 3 · 2023: 4 · 2022: 5 · 2021: 4 · 2020: 4 · 2019: 1
FWCI
4.71
Type
journal article
Language
en
Open access
Licence
Locations
  • Pediatric Quality and Safety (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
National Center for Research Resources (UL1RR025780)
Topics
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
Keywords
diagnostic errors, clinician comfort, safety culture, patient safety, morbidity and mortality conferences, medical errors, peer judgment, pediatric clinicians, medical error reporting

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