What do healthcare managers do after a mistake? Improving responses to medical errors with organizational behavior management

Abstract

Although several organizational behavior management (OBM) intervention techniques have been used to improve designated behaviors related to patient safety, there remains a lack of patient-safety-focused behavioral interventions among healthcare workers. OBM interventions are often applied to needs already identified within an organization, and the means by which these needs are determined vary across applications. The current research addresses gaps in the literature by translating OBM intervention techniques to identify and improve the prevention potential of responses to reported medical errors. A content analysis of 17 months of descriptions of follow-up actions to error reports for nine types of the most-frequently occurring errors was conducted. Follow-up actions were coded according to a taxonomy of behavioral intervention components, with accompanying impact scores based on criteria developed by Geller et al. Two error types were selected for intervention, based on the highest frequency of reporting and lowest average follow-up intervention impact score. Over a 3-month intervention period, managers were instructed to respond to these two error types with active communication, group feedback, and positive recognition strategies. Results indicate improved prevention potential as a consequence of improved corrective action for targeted errors, with rates of individual and group feedback delivery increasing by 10–35% for managers' responses to targeted error types. Future implications for identifying and classifying responses to medical error are discussed.

Keywords:

• Patient safety
• Medical error
• Organizational behavior management
• Communication intervention
• Content analysis

Acknowledgements

The research reported here was conducted by the first author in fulfillment of his PhD degree in clinical psychology from Virginia Polytechnic Institute and State University, under the mentorship of the coauthor. The authors gratefully acknowledge the assistance of our many research assistants in the Center for Applied Behavior Systems who provided valuable assistance in this effort, particularly Remmie L Arnold and Philip A Randall.

Additional information

Notes on contributors

Thomas R Cunningham

Thomas R Cunningham is a behavioral scientist with the National Institute for Occupational Safety and Health in the Education and Information Division. His research addresses positive behavior-based intervention development for safety and health applications, and has included several investigations of increasing safety-related behaviors among healthcare workers. He received his MS and PhD degrees in clinical psychology from Virginia Polytechnic Institute and State University.

E Scott Geller

E Scott Geller is an Alumni Distinguished Professor at Virginia Tech where he is a member of the Department of Psychology. He has taught and conducted applied/experimental research for four decades. In this capacity, Dr Geller has authored more than 350 research articles and over 50 books or chapters addressing the development and evaluation of behavior-change interventions to improve quality of life.