The Patient Safety Collaborative

Making a difference - Prevention Systems for Patient Safety

Accountability Vs Anonymity

This is, perhaps, the hot topic currently being debated as disagreement remains about the attributes of the ideal reporting system.For Accountability

Real lessons leading to performance improvement from any adverse incident can only be learned after a full and detailed root cause analysis of the incident has been completed. Until the investigators are sure that they have sufficient, genuine information to understand the incident properly, they cannot be certain that their analysis of the incident will be accurate. The analysts will therefore need the opportunity to ask further questions of the reporter and other individuals concerned with the reported incident. Anonymous reports may come from individuals who have misinterpreted the facts or failed to identify important contributing factors and without independent follow up and verification, such important information would be lost.

For Anonymity

The counter argument is that the fear of reprisal will prevent individuals from reporting. As Bill Runciman (President of the Australian Patient Safety Foundation) et al state in their editorial Improving Patients’ Safety by Gathering Information (BMJ 2001;323:298):

“A doctor is unlikely to report if he or she knows that (this) information, associated with his or her name, will be retained somewhere in a file or databank. Assurances of confidentiality may not be enough; those who know how diluted the principle of medical confidentiality has become might be forgiven for questioning whether highly incriminating information passed on to (hospital) authorities will go no further. If reporting is anonymous, however, such a doctor will have nothing to lose and might be more motivated to report the problem to prevent its recurrence.”

The recent studies carried out in conjunction with The Robert Graham Center showed that doctors will report errors and near misses if their anonymity is assured, but it also has to be recognised that no comparative studies where doctors have had to identify themselves have so far been carried out.

NPSA’s Position

The importance of this debate has seen the NPSA’s position on this issue being subject to change, moving from “We will not be seeking anonymous reports” as of 2nd May 2002, to “All information supplied to the NPSA, through the national reporting system, will be anonymous” as of 13th June, 2002. (FAQ’s on www.npsa.org.uk <http://www.npsa.org.uk>).

However, behind the anonymous reporting to the NPSA is the requirement for any organisation reporting a “Red Alert” incident to the NPSA to also report, within 45 days, of the outcome of the reporting organisation’s analysis of the causes of the incident (root cause analysis).

This therefore implicitly requires the reporting organisation to retain details of the individuals concerned in the incident in their data files.

TPSC Aims

We aim to keep you fully informed, involved and contributing to this debate, as no reporting system will work adequately unless it addresses both the legitimate concerns of those filing the reports and the requirements of the managers and administrators dealing with the reports and their consequences.

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