---
title: "Patient safety"
chunk: 9/10
source: "https://en.wikipedia.org/wiki/Patient_safety"
category: "reference"
tags: "science, encyclopedia"
date_saved: "2026-05-05T04:26:13.019610+00:00"
instance: "kb-cron"
---

=== Complex illness ===
Pay-for-performance programs often target patients with serious and complex illnesses; such patients commonly interact with multiple healthcare providers and facilities. However, pilot programs now underway focus on simple indicators such as improvement in lab values or use of emergency services, avoiding areas of complexity such as multiple complications or several treating specialists. A 2007 study analyzing Medicare beneficiaries' healthcare visits showed that a median of two primary care physicians and five specialists provide care for a single patient. The authors doubt that pay-for-performance systems can accurately attribute responsibility for the outcome of care for such patients. The American College of Physicians Ethics has stated concerns about using a limited set of clinical practice parameters to assess quality, "especially if payment for good performance is grafted onto the current payment system, which does not reward robust comprehensive care...The elderly patient with multiple chronic conditions is especially vulnerable to this unwanted effect of powerful incentives." Present pay-for-performance systems measure good performance based on specified clinical measurements, such as glycohemoglobin for diabetic patients. Healthcare providers who are monitored by such limited criteria have a powerful incentive to deselect (dismiss or refuse to accept) patients whose outcome measures fall below the quality standard and therefore worsen the provider's assessment. Patients with low health literacy, inadequate financial resources to afford expensive medications or treatments, and ethnic groups traditionally subject to healthcare inequities may also be deselected by providers seeking improved performance measures.

== Public reporting ==

=== Mandatory reporting ===

==== Denmark ====
The Danish Act on Patient Safety passed Parliament in June 2003. On January 1, 2004, Denmark became the first country to introduce nationwide mandatory reporting. The Act obligates front line personnel to report adverse events to a national reporting system. Hospital owners are obligated to act on the reports and the National Board of Health is obligated to communicate the learning nationally. The reporting system is intended purely for learning and front line personnel cannot experience sanctions for reporting. This is stated in Section 6 of the Danish Act on Patient Safety (as of January 1, 2007: Section 201 of the Danish Health Act): "A front line person who reports an adverse event cannot as a result of that report be subjected to investigation or disciplinary action from the employer, the Board of Health or the Court of Justice." The reporting system and the Danish Patient Safety Database are described in further detail in a National Board of Health publication.

==== United Kingdom ====
The National Patient Safety Agency encourages voluntary reporting of health care errors but has several specific instances, known as "Confidential Enquiries", for which investigation is routinely initiated: maternal or infant deaths, childhood deaths to age 16, deaths in persons with mental illness, and perioperative and unexpected medical deaths. Medical records and questionnaires are requested from the involved clinician, and participation has been high, since individual details are confidential.

==== United States ====
The 1999 Institute of Medicine (IOM) report recommended "a nationwide mandatory reporting system ... that provides for ... collection of standardized information by state governments about adverse events that result in death or serious harm." Professional organizations, such as the Anesthesia Patient Safety Foundation, responded negatively: "Mandatory reporting systems, in general, create incentives for individuals and institutions to play a numbers game. If such reporting becomes linked to punitive action or inappropriate public disclosure, there is a high risk of driving reporting "underground", and of reinforcing the cultures of silence and blame that many believe are at the heart of the problems of medical error..."
Although 23 states established mandatory reporting systems for serious patient injuries or death by 2005, the national database envisioned in the IOM report was delayed by the controversy over mandatory versus voluntary reporting. Finally in 2005, the US Congress passed the long-debated Patient Safety and Quality Improvement Act, establishing a federal reporting database. Hospitals reports of serious patient harm are voluntary, collected by patient safety organizations under contract to analyze errors and recommend improvements. The federal government serves to coordinate data collection and maintain the national database. Reports remain confidential and cannot be used in liability cases. Consumer groups have objected to the lack of transparency, claiming it denies the public information on the safety of specific hospitals.

==== Sweden ====
According to the Patient Safety Law (Patientsäkerhetslagen) healthcare providers must report incidents that resulted or could have resulted in serious medical damage to Health and Social Care Inspectorate (known as Lex Maria notification).

=== Individual patient disclosures ===
For a healthcare institution, disclosing an unanticipated event should be made as soon as possible. Some healthcare organizations may have a policy regarding the disclosure of unanticipated events. The amount of information presented to those affected is dependent on the family's readiness and the organization's culture. The employee disclosing the event to the family requires support from risk management, patient safety officers, and senior leadership. Disclosures are objectively documented in the medical record.

=== Voluntary disclosure ===
In public surveys, a significant majority of those surveyed believe that health care providers should be required to report all serious medical errors publicly. However, reviews of the medical literature show little effect of publicly reported performance data on patient safety or the quality of care. Public reporting on the quality of individual providers or hospitals does not seem to affect selection of hospitals and individual providers. Some studies have shown that reporting performance data stimulates quality improvement activity in hospitals. As of 2012, only one in seven errors or accidents are reported, showing that most errors that happen are not reported.

==== United States ====