471 Joint Commission on Quality and Safety Journal September 2004 Volume 30 Number 9 Using Focus Groups to Understand Physicians’ and Nurses’ Perspectives on Error Reporting in Hospitals Patient Safety Donna B. Jeffe, Ph.D. William Claiborne Dunagan, M.D. Jane Garbutt, M.B., Ch.B. Thomas E. Burroughs, Ph.D. Thomas H. Gallagher, M.D. Patricia R. Hill, R.N., B.S.N. Carolyn B. Harris, M.P.H. Kerry Bommarito, M.P.H. Victoria J. Fraser, M.D. I n its report on the public health risk of medical errors, the Institute of Medicine also recommended expanding error reporting to improve patient safe- ty. 1 However, health care workers’ willingness to report medical errors to their health care institutions is compli- cated by many factors, both environmental/institutional (relating to the physical environment, hospital systems, and policies) and personal (relating to characteristics of both health care workers and patients). In spite of dis- cussions suggesting that greater error reporting would improve patient safety, 1–6 finding ways to improve report- ing remains a challenge. To gain insight into workers’ perspectives about key concepts and issues regarding medical error reporting in hospitals, we conducted several focus groups with physi- cians and nurses working in hospitals in BJC HealthCare in St. Louis, Missouri, one of the largest nonprofit health systems in the United States. Conducting a needs assess- ment from the perspectives of workers within a given system is a crucial first step in designing successful interventions to bring about behavioral and policy change. 7 In this article we report the major themes that emerged from our analysis of responses to particular questions about barriers to reporting, reasons for reporting, and suggestions for improving reporting. We consider the focus group data within the context of the equity implementation model, 8 a model that helps us Background: To increase error reporting, a better understanding of physicians’ and nurses’ perspectives regarding medical error reporting in hospitals, barriers to reporting, and possible ways to increase reporting is necessary. Methods: Nine focus groups—four with 49 staff nurses, two with 10 nurse managers, and three with 30 physicians—from 20 academic and community hospi- tals were conducted in May–June 2002 in the St. Louis metropolitan area. Qualitative analysis of focus group transcripts characterized participants’ perspectives. Results: Although participants knew they should report errors associated with serious adverse events, there was much uncertainty about reporting less serious errors or near misses. Nurses were more knowledgeable than physicians about how to report errors. All groups mentioned barriers to reporting, such as fear of reprisals and lack of confidentiality, time, and feedback after an error is reported. Some physicians doubted the benefit of reporting errors, but, generally, both physicians and nurses agreed that reporting was intended to change practice and policy to promote patient safety. Conclusions: A culture characterized by anonymous reporting, freedom from repercussions, and feedback about error reports should promote error reporting. Article-at-a-Glance Copyright 2004 Joint Commission on Accreditation of Healthcare Organizations