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Objective. Our primary objective was to determine whether, after training was offered to participants, those who indicated they had received error disclosure training previously were more likely to disclose a hypothetical error and have more positive perceptions of their organizational culture pertaining to error disclosure, safety, and teamwork.

Methods. Across a 3-year span, all clinical faculty from six health institutions (four medical schools, one cancer center, and one health science center) in The University of Texas System were offered the opportunity to anonymously complete an electronic survey focused on measuring error disclosure culture, safety culture, teamwork culture, and intention to disclose a hypothetical error at two time points—both before (baseline) and after (follow-up) disclosure training was conducted for a subset of faculty.

Results. There were significant improvements (all p-values < .05) in the follow-up surveys compared with the baseline surveys for the following domains (percent refers to percent positives before and after, respectively): minor error disclosure culture (33 percent vs. 52 percent), serious error disclosure (53 percent vs. 70 percent), safety culture (50 percent vs. 63 percent), and teamwork culture (62 percent vs. 73 percent). Follow-up survey data revealed significant differences (all p-values < .001) between faculty who had previously received any error disclosure training (n = 472) and those who had not (n = 599). Specifically, we found significant differences in culture (all p-values < .001) between those who received any error disclosure training and those who did not for all culture domains: minor error disclosure (61 percent vs. 41 percent), serious error disclosure (79 percent vs. 58 percent), trust-based error disclosure (61 percent vs. 51 percent), safety (73 percent vs. 51 percent), and teamwork (78 percent vs. 66 percent). Significant differences also existed for intent to disclose an error (t = 4.1, p < .05). We also found that error disclosure culture was significantly associated with intent to disclose for those who received previous error disclosure training, whereas all types of culture we measured were significantly associated with intent to disclose for those who did not receive error disclosure training.

Conclusions. Error disclosure, teamwork, and safety culture all improved over a 3-year period during which disclosure training was provided to key faculty in these six institutions. Self‑reported likelihood to disclose errors also improved. The precise impact of the training on these improvements cannot be determined from this study; nevertheless, we present an approach to measuring error disclosure culture and providing training that may be useful to other institutions.

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Agency for Healthcare Research and Quality


Rockville, MD


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James Battles, Irim Azam, Mary Grady, & Kathryn Reback

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Advances in Patient Safety and Medical Liability

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