Effects of Shame and Guilt on Error Reporting Among Obstetric Clinicians

Abstract

Objective: To understand how the experiences of shame and guilt, coupled with organizational factors, affect error reporting by obstetric clinicians.

Design: Descriptive cross-sectional.

Setting and participants: A sample of 84 obstetric clinicians from three maternity units in Washington State.

Methods: In this quantitative inquiry, a variant of the Test of Self-Conscious Affect was used to measure proneness to guilt and shame. In addition, we developed questions to assess attitudes regarding concerns about damaging one's reputation if an error was reported and the choice to keep an error to oneself. Both assessments were analyzed separately and then correlated to identify relationships between constructs. Interviews were used to identify organizational factors that affect error reporting.

Results: As a group, mean scores indicated that obstetric clinicians would not choose to keep errors to themselves. However, bivariate correlations showed that proneness to shame was positively correlated to concerns about one's reputation if an error was reported, and proneness to guilt was negatively correlated with keeping errors to oneself. Interview data analysis showed that Past Experience with Responses to Errors, Management and Leadership Styles, Professional Hierarchy, and Relationships With Colleagues were influential factors in error reporting.

Conclusion: Although obstetric clinicians want to report errors, their decisions to report are influenced by their proneness to guilt and shame and perceptions of the degree to which organizational factors facilitate or create barriers to restore their self-images. Findings underscore the influence of the organizational context on clinicians' decisions to report errors.

Keywords: culture; error reporting; guilt; organizational factors; shame.