Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 143 No. 2728 (2013)

Implementation status of error disclosure standards reported by Swiss hospitals

  • Stuart McLennan
  • Sabrina Engel
  • Katharina Ruhe
  • Agnes Leu
  • David Schwappach
  • Bernice Elger
Cite this as:
Swiss Med Wkly. 2013;143:w13820


QUESTION UNDER STUDY: To establish at what stage Swiss hospitals are in implementing an internal standard concerning communication with patients and families after an error that resulted in harm.

METHODS: Hospitals were identified via the Swiss Hospital Association’s website. An anonymous questionnaire was sent during September and October 2011 to 379 hospitals in German, French or Italian. Hospitals were asked to specify their hospital type and the implementation status of an internal hospital standard that decrees that patients or their relatives are to be promptly informed about medical errors that result in harm.

RESULTS: Responses from a total of 205 hospitals were received, a response rate of 54%. Most responding hospitals (62%) had an error disclosure standard or planned to implement one within 12 months. The majority of responding university and acute care (75%) hospitals had introduced a disclosure standard or were planning to do so. In contrast, the majority of responding psychiatric, rehabilitation and specialty (53%) clinics had not introduced a standard.

CONCLUSION: It appears that Swiss hospitals are in a promising state in providing institutional support for practitioners disclosing medical errors to patients. This has been shown internationally to be one important factor in encouraging the disclosure of medical errors. However, many hospitals, in particular psychiatric, rehabilitation and specialty clinics, have not implemented an error disclosure policy. Further research is needed to explore the underlying reasons.


  1. National Patient Safety Agency. Being Open: Saying Sorry When Things Go Wrong. NHS: National Patient Safety Agency; 2009.
  2. Canadian Patient Safety Institute. Canadian Disclosure Guidelines. Ottawa: Canadian Patient Safety Institute; 2008.
  3. Australian Commission on Safety and Quality in Health Care. Open Disclosure Standard: A National Standard for Open Communication in Public and Private Hospitals, Following an Adverse Event in Health Care. Sydney: ACSQHC; 2008.
  4. Massachusetts Coalition for the Prevention of Medical Errors. When Things go Wrong: Responding to Adverse Events. A Consensus Statement of the Harvard Hospitals. Massachusetts Coalition for the Prevention of Medical Errors; 2006.
  5. Aubert de la Ruee R. Medizinische Behandlungsfehler und Patientenrechte in Schweden. Schweizerische Ärztezeitung. 2007;88:46.
  6. Gallagher TH, Waterman AD, Ebers AG, Fraser VJ, Levinson W. Patients’ and physicians’ attitudes regarding the disclosure of medical errors. JAMA. 2003;289:1001–7.
  7. Iedema R, Sorensen R, Manias E, Tuckett A, Piper D, Mallock N, Williams A, Jorm C. Patients’ and family members’ experience of open disclosure following adverse events. Int J Qual Health Care. 2008;20:421–32.
  8. Cleopas A, Villaveces A, Charvet A, Bovier PA, Kolly V, Perneger TV. Patient assessments of a hypothetical medical error: effects of health outcome, disclosure, and staff responsiveness. Qual Saf Health Care. 2006;15:136–41.
  9. Gallagher TH, Bell SK, Smith KM, Mello MM, McDonald TB. Disclosing Harmful Medical Errors to Patients: Tackling Three Tough Cases. Chest. 2009;136:897–903.
  10. Gallagher TH, Lucus MH. Should we disclose harmful medical errors to patients? If so, how? J Clin Outcomes Manag. 2005; 12:253–9.
  11. Schwappach DLB, Frank O, Hochreutener MA. ‘New perspectives on well-known issues’: Patients’ experiences and perceptions of safety in Swiss hospitals. Z. Evid. Fortbild. Qual. Gesundh. wesen (ZEFQ) 2011;105:542–8.
  12. Iedema R, Allen S, Sorensen R, Gallagher TH. What Prevents Incident Disclosure, and What Can Be Done to Promote It? Jt Comm J Qual Patient Saf. 2011;37:409–17.
  13. Gallagher T, Waterman AD, Garbutt JM, Kapp JM, Chan DK, Dunagan WC, Fraser VJ, Levinson W. US and Canadian physicians’ attitudes and experiences regarding disclosing errors to patients. Arch Intern Med. 2006;166:1605–11.
  14. von Laue N, Schwappach DLB, Hochreutener MA. “Second victim” – error, crises and how to get out of it. Therapeutische Umschau. 2012;69:367–70.
  15. McLennan S, Beitat K, Lauterberg J, Vollmann J. Regulating Open Disclosure: A German Perspective. Int J Qual Health Care. 2012;24:23–7.
  16. Iedema R, Mallock N, Sorensen R, et al. Final Report: Evaluation of the National Open Disclosure Pilot Program. Sydney: Australian Commission on Safety and Quality in Health Care; 2008.
  17. Institute of Medicine. To err is human: building a safer health system. Washington, D.C.: The National Academies Press, 2000.
  18. Schweizerische Akademie der Medizinischen Wissenschaften. Aus- und Weiterbildung in Patientensicherheit und Fehlerkultur. Projekt «Zukunft Medizin Schweiz» – Phase lll. Bern, 2007.
  19. SAMW. Aktuell gültige Richtlinien. (last accessed 08.10.2012)
  20. Bundesgesetz vom 18. März 1994 über die Krankenversicherung (KVG), SR 832.10.
  21. Briner M, Kessler O, Pfeiffer Y, Wehner T, Manser T. Assessing hospitals’ clinical risk management: Development of a monitoring instrument BMC Health Services Research 2010;10:337.
  22. Lauterberg J, Blum K, Briner M, Lessing C. Abschlussbericht: Befragung zum Einführungsstand von klinischen Risiko-Management (kRM) in deutschen Krankenhäusern. Bonn: Institut für Patientensicherheit der Universität Bonn, 2012.
  23. Rabia L, Rothhardt V. Aussergerichtliche FMH-Gutachterstelle-Jahresbericht 2011. Schweizerische Ärztezeitung. 2012;93:803–6.
  24. Thomas EJ, Studdert DM, Runciman WB, et al. A comparison of iatrogenic injury studies in Australia and the USA. I: context, methods, casemix, population, patient and hospital characteristics, Int J Qual Health Care. 2000;12:371–8.
  25. Runciman WB, Webb RK, Helps SC, et al. A comparison of iatrogenic injury studies in Australia and the USA. II: reviewer behaviour and quality of care, Int J Qual Health Care. 2000;12:379–88.
  26. Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ. 2001;322:517–9.
  27. Davis P, Lay-Yee R, Briant R, et al. Adverse events in New Zealand public hospitals: principal findings from a national survey. Wellington, New Zealand: Ministry of Health, 2001.
  28. Schioler T, Lipczak H, Pedersen BL, et al. Incidence of adverse events in hospitals. A retrospective study of medical records (in Danish). Ugeskr Laeger. 2001;163:5370–8.
  29. Baker GR, Norton PG, Flintoft V, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ. 2004;170:1678–86.
  30. Nath SB, Marcus SC. Medical Errors in Psychiatry. Harv Rev Psychiatry. 2006;14:204–11.
  31. Lamb RM, Studdert DM, Bohmer RMJ, Berwick DM, Brennan TA. Hospital Disclosure Practices: Results Of A National Survey. Health Affairs. 2003;22:73–83.
  32. Weissman JS, Annas CL, Epstein AM, Schneider EC, Clarridge B, Kirle L, et al. Error Reporting and Disclosure Systems: Views From Hospital Leaders. JAMA. 2005;293:1359–66.
  33. Gallagher TH, Brundage G, Bommarito KM, Summy EA, Ebers AG, Waterman AD, Fraser VJ, Dunagan C. National survey: Risk managers’ attitudes and experiences regarding patient safety and error disclosure. ASHRM J. 2006;26:11–6.
  34. Briner M, Manser T, Kessler O. Clinical risk management in hospitals: strategy, central coordination and dialogue as key enablers. J Eval Clin Pract. 2013;19(2):363–9.
  35. Morris-Donovan B, Hopkins G, Watts I. Regaining trust after an adverse event: An education module on managing adverse events in general practice. The Royal Australian College of General Practitioners, 2008.
  36. Hobgood C, Peck CR, Gilbert B, Chappell K, Zou B. Medical Errors – What and When: What Do Patients Want to Know? Acad Emerg Med. 2002;9:1156–61.
  37. Lopez L, Weissman JS, Schneider EC, Weingart SN, Cohen AP, Epstein AM. Disclosure of Hospital Adverse Events and Its Association With Patients’ Ratings of the Quality of Care. Arch Intern Med. 2009;169:1888–94.
  38. Helmreich RL, Merritt AC. Culture at Work in Aviation and Medicine. National, Organisational and Professional Influences. Aldershot: Ashgate Publishing Limited; 1998.
  39. Baruch Y, Holtom BC. Survey response rate levels and trends in organizational research. Human Relations. 2008;6:1139–60.

Most read articles by the same author(s)

1 2 > >>