1. Coping with medical error: the case of the
health professional
Dr Reema Harrison1, Professor Rebecca Lawton2, Professor Gerry Armitage3, Dr Peter
Gardner2, Dr Jo Shapiro4, Jessica Perlo5
1 University of Sydney, Australia
2 University of Leeds, UK
3 University of Bradford, UK
4 Brigham and Women’s Hospital, USA
5 Institute for Healthcare Improvement, USA
School of Public Health | Sydney Medical School

2. Patient harm from medical care
Adverse events:
patient harm from
medical care.
Medical errors
cause over 50%1.
28% of errors from
negligence.
Many unintentional
mistakes.
1 Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes B, et al. The nature of adverse events in hospitalized
patients: results of the Harvard Medical Practice Study II. New England journal of medicine 1991; 324(6): 377-384.

3. Psychological origins of error
Large proportion
of errors have
psychological
origins
e.g. attentional
lapses in highly
routinized
procedures
requiring close
attention

4. Tendency to blame
Human tendency to blame others’ mistakes on their
personal characteristics (ability, personality, attitudes).
Tendency stronger when the outcome of the mistake is
more severe (i.e. greater patient harm).
Would most HP’s in the same situation make the same
mistake – situation not person to blame?
Difficult to move away from blame even when we know
‘person-centred’ strategies reduce error rates.

5. Making an error
Guilt
Error
Shame
Depression
Anxiety
Incompetent
Lose
confidence
Systematic
reviews2
demonstrate
consistent effects
of making a
medical error:
2Sirriyeh et al (2010); Seys et al (2012)

6. Gaps in Knowledge
Lack of large scale
studies
Absence of
control/comparison
group
Lack of cross-country
data– small
scale studies
Limited data on
coping strategies
health
professionals use
Lack of knowledge
about supporting
health
professionals who
make errors

7. Present Study
Cross-sectional
survey of
health
professionals in
2 academic
hospitals in the
UK and USA.
WE INVESTIGATED:
• the professional or
personal disruption that
result from making an
error;
• professionals’ emotional
responses and the coping
strategies they use;
• the relationship between
the emotions they
experience and the coping
strategy that is used;
• perceptions of
organisational support.

8. Sample & settings
› UK: 1 large teaching hospital Trust in northern England
› USA: 1 large academic hospital in Boston, MA
› Doctors and nurses at level of seniority in any department/ward
› Recruitment via:
• Organisational newsletters
• E-mail distribution lists
• Organisational intranet
• Paper copies in training sessions/wards.

9. Method
Survey tool
created and
validated in
the UK
Ethics
approval
obtained
each hospital.
Study
invitations &
survey
distributed
265
respondents:
120 doctors;
145 nurses
Data analysis
- SPSS &
framework
analysis

10. HPEEQ Survey Tool
5 components:
• Demographic information
• Error characteristics – severity, time since
• Emotional responses (PANAS)
• Coping strategies (FDCS)
• Free text items - org. support

11. Findings
Professional and personal
disruption prevalent - negative
emotions common
Positive feelings of determination,
attentiveness and alertness.
Emotional response and coping
strategy selection did not differ
between countries or level of pt
harm
Nurses in both locations reported
stronger negative feelings.

12. Findings cont.
Problem-focused coping
strategies favoured.
Associations between coping
strategy used and particular
emotional responses.
Peers were most valued support.
Fears over confidentiality prohibit
staff from accessing formal org.
support.

13. What does this mean for nurses?
› Making a medical error = detrimental to health professionals’ well-being
& safe patient care.
› Nurses particularly vulnerable - greater exposure to punitive action -
may require additional support.
› Building psychological resilience - an individual's ability to adapt to
stress and adversity; to be positive, optimistic & to learn from mistakes.
› Not everyone is equally resilient – importance of being part of a team/
being able to access social support.
› Peers support - promote psychological resilience & protect patients.

14. Thank you!
Email: reema.harrison@sydney.edu.au
School of Public Health | Sydney Medical School