POWER AND DISCLOSURE IN HEALTHCARE: A SCOPING REVİEW OF MEDICAL ERROR RESPONSE ACROSS SYSTEMS

Year 2025, Volume: 10 Issue: 3, 305 - 317, 24.10.2025

Stephanie Quon , Sarah Low , Sarah Zhou , Katherine Zheng

https://doi.org/10.33457/ijhsrp.1675607

Abstract

Background: Medical errors remain as a troubling cause of preventable harm within healthcare systems. In response, error disclosure has emerged as both an ethical imperative and a quality improvement priority. Despite increasing institutional and legal support for transparency, disclosure practices are often hindered by emotional, organizational, and systemic barriers.
Objective: This scoping review consolidates evidence on medical error disclosure and response, with particular attention to strategies that address power dynamics, communication practices, legal protections, organizational culture, and community engagement.
Methods: A curated body of peer-reviewed literature from 2000 to 2025 was analyzed using an integrative and interpretive approach. Sources were drawn from medicine, public health, ethics, law, and education, and categorized across ten thematic domains: disclosure and communication; support for healthcare professionals; systematic learning; safety culture; legal and ethical considerations; restorative approaches; surveillance; education; interdisciplinary insights; and community-led models.
Results: Findings highlight that effective disclosure is supported by structured frameworks (e.g., CANDOR), legal protections (e.g., apology laws), and organizational policies that promote psychological safety. Emerging innovations include patient-partnered education, virtual training modules, interdisciplinary root cause analysis, and community-informed participatory models. However, gaps remain in sustainability, long-term outcomes, and integration of equity and power-sensitive approaches.
Conclusions: Medical error response is evolving from isolated clinician responsibility to an integrated, systems-based practice. Sustainable progress requires alignment of institutional culture, legal reform, emotional support, and patient engagement. By embracing relational, transparent, and justice-oriented frameworks, healthcare systems can transform error disclosure into a meaningful catalyst for healing, accountability, and trust

Keywords

Medical error disclosure , patient safety , transparency , systems-based response , restorative justice , organizational culture , communication training , second victim support , legal protections , healthcare quality improvement

Ethical Statement

This study did not involve the use of human participants, animals, or hazardous materials. As such, ethics approval was not required. All data used in this scoping review were obtained from publicly available published literature.

Thanks

The authors gratefully acknowledge the support and resources that made this work possible. No specific individuals or organizations contributed directly to the development of this manuscript.

References

• Sigman, L., et al., “Disclosure of Adverse Events in Pediatrics: Policy Statement,” Pediatrics, 155(4), e2025070880, 2025.
• Prentice, J. C., et al., “Association of open communication and the emotional and behavioural impact of medical error on patients and families: state-wide cross-sectional survey,” BMJ Quality & Safety, 29(11), 883–894, 2020.
• Miziara, I. D., and Miziara, C. S. M. G., “Recognition of medical error: It is not too late for an open disclosure – a narrative review,” Clinics, 80, 100622, 2025.
• Kaldjian, L. C., “Communication about medical errors,” Patient Education and Counseling, 104(5), 989–993, 2021.
• O’Connor, E., Coates, H. M., Yardley, I. E., and Wu, A. W., “Disclosure of patient safety incidents: a comprehensive review,” International Journal for Quality in Health Care, 22(5), 371–379, 2010.
• Tricco, A. C., et al., “PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation,” Annals of Internal Medicine, 169(7), 467–473, 2018.
• Page, M. J., et al., “The PRISMA 2020 statement: an updated guideline for reporting systematic reviews,” BMJ, n71, 2021.
• Rathnayake, D., Sasame, A., Radomska, A., Shé, É. N., McAuliffe, E., and De Brún, A., “What can we learn from patient and family experiences of open disclosure and how they have been evaluated? A systematic review,” BMC Health Services Research, 25(1), 238, 2025.
• Schwappach, D. L. B., “Nach dem Behandlungsfehler: Umgang mit Patienten, Angehörigen und dem involvierten Personal,” Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz, 58(1), 80–86, 2015.
• Bell, S. K., Moorman, D. W., and Delbanco, T., “Improving the Patient, Family, and Clinician Experience After Harmful Events: The ‘When Things Go Wrong’ Curriculum,” Academic Medicine, 85(6), 1010–1017, 2010.
• Larson, E. B., “Measuring, Monitoring, and Reducing Medical Harm from a Systems Perspective: A Medical Director’s Personal Reflections,” Academic Medicine, 77(10), 993–1000, 2002.
• Conway, A. E., et al., “Leveraging learning systems to improve quality and patient safety in allergen immunotherapy,” Annals of Allergy, Asthma & Immunology, 132(6), 694–702, 2024.
• Pettker, C. M., “Systematic approaches to adverse events in obstetrics, Part II: Event analysis and response,” Seminars in Perinatology, 41(3), 156–160, 2017.
• Iedema, R. A. M., Jorm, C., Long, D., Braithwaite, J., Travaglia, J., and Westbrook, M., “Turning the medical gaze in upon itself: Root cause analysis and the investigation of clinical error,” Social Science & Medicine, 62(7), 1605–1615, 2006.
• Vincent, C., et al., “Systems analysis of clinical incidents: development of a new edition of the London Protocol,” BMJ Quality & Safety, 34(6), 413–420, 2025.
• Connor, M., et al., “Creating a Fair and Just Culture: One Institution’s Path Toward Organizational Change,” The Joint Commission Journal on Quality and Patient Safety, 33(10), 617–624, 2007.
• Murray, J. S., Clifford, J., Larson, S., Lee, J. K., and Sculli, G. L., “Implementing Just Culture to Improve Patient Safety,” Military Medicine, 188(7–8), 1596–1599, 2023.
• Quon, S., Zhou, S., and Tan, J., “In support of institutional self-reflection on social accountability,” Canadian Medical Education Journal, 2025.
• Mira, J. J., et al., “Lessons learned for reducing the negative impact of adverse events on patients, health professionals and healthcare organizations,” International Journal for Quality in Health Care, 29(4), 450–460, 2017.
• Brattebø, G., and Flaatten, H. K., “Errors in medicine: punishment versus learning medical adverse events revisited – expanding the frame,” Current Opinion in Anaesthesiology, 36(2), 240–245, 2023.
• Quon, S., and Low, S., “Bridging the gap in biomedical engineering education by integrating local context,” Research and Development in Medical Education, 13, 18, 2024.
• Moore, J., Bismark, M., and Mello, M. M., “Patients’ Experiences With Communication-and-Resolution Programs After Medical Injury,” JAMA Internal Medicine, 177(11), 1595, 2017.
• Quon, S., and Zhou, S., “Enhancing physical accessibility education in medical schools: Bridging the gap for inclusive healthcare,” Advances in Biomedical and Health Sciences, 4(2), 47–51, 2025.
• Dahan, S., Ducard, D., and Caeymaex, L., “Apology in cases of medical error disclosure: Thoughts based on a preliminary study,” PLOS ONE, 12(7), e0181854, 2017.
• Plews-Ogan, M., May, N., Owens, J., Ardelt, M., Shapiro, J., and Bell, S. K., “Wisdom in Medicine: What Helps Physicians After a Medical Error?,” Academic Medicine, 91(2), 233–241, 2016.
• Moore, J., and Mello, M. M., “Improving reconciliation following medical injury: a qualitative study of responses to patient safety incidents in New Zealand,” BMJ Quality & Safety, 26(10), 788–798, 2017.
• Dijkstra, R. I., Roodbeen, R. T. J., Bouwman, R. J. R., Pemberton, A., and Friele, R., “Patients at the centre after a health care incident: A scoping review of hospital strategies targeting communication and nonmaterial restoration,” Health Expectations, 25(1), 264–275, 2022.
• Quon, S., and Zhou, S., “Enhancing physical accessibility education in medical schools: Bridging the gap for inclusive healthcare,” Advances in Biomedical and Health Sciences, 4(2), 47–51, 2025.
• Liukka, M., et al., “Action after Adverse Events in Healthcare: An Integrative Literature Review,” International Journal of Environmental Research and Public Health, 17(13), 4717, 2020.
• Henneman, E. A., “Recognizing the Ordinary as Extraordinary: Insight Into the ‘Way We Work’ to Improve Patient Safety Outcomes,” American Journal of Critical Care, 26(4), 272–277, 2017.
• Stroud, L., Wong, B. M., Hollenberg, E., and Levinson, W., “Teaching Medical Error Disclosure to Physicians-in-Training: A Scoping Review,” Academic Medicine, 88(6), 884–892, 2013.
• Derse, A. R., “Medical Training and Errors: Competence, Culture, Caring, and Character,” Academic Medicine, 95(8), 1155–1158, 2020.
• Ryder, H. F., Huntington, J. T., West, A., and Ogrinc, G., “What Do I Do When Something Goes Wrong? Teaching Medical Students to Identify, Understand, and Engage in Reporting Medical Errors,” Academic Medicine, 94(12), 1910–1915, 2019.
• Shepherd, L., Chilton, S., and Cristancho, S. M., “Residents, Responsibility, and Error: How Residents Learn to Navigate the Intersection,” Academic Medicine, 98(8), 934–940, 2023.
• Quon, S., and Zhou, S., “Enhancing AI-Driven Medical Translations: Considerations for Language Concordance,” JMIR Medical Education, 11, e70420, 2025.
• Fischer, M. A., Mazor, K. M., Baril, J., Alper, E., DeMarco, D., and Pugnaire, M., “Learning from mistakes: Factors that influence how students and residents learn from medical errors,” Journal of General Internal Medicine, 21(5), 419–423, 2006.
• Shepherd, L., LaDonna, K. A., Cristancho, S. M., and Chahine, S., “How Medical Error Shapes Physicians’ Perceptions of Learning: An Exploratory Study,” Academic Medicine, 94(8), 1157–1163, 2019.
• Robertson, J. J., and Long, B., “Suffering in Silence: Medical Error and its Impact on Health Care Providers,” Journal of Emergency Medicine, 54(4), 402–409, 2018.
• Langer, T., Martinez, W., Browning, D. M., Varrin, P., Sarnoff Lee, B., and Bell, S. K., “Patients and families as teachers: a mixed methods assessment of a collaborative learning model for medical error disclosure and prevention,” BMJ Quality & Safety, 25(8), 615–625, 2016.
• Etchegaray, J. M., et al., “Patients as Partners in Learning from Unexpected Events,” Health Services Research, 51(S3), 2600–2614, 2016.
• Aveling, E.-L., Martin, G., Herbert, G., and Armstrong, N., “Optimising the community-based approach to healthcare improvement: Comparative case studies of the clinical community model in practice,” Social Science & Medicine, 173, 96–103, 2017.
• American Diabetes Association Professional Practice Committee, et al., “10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025,” Diabetes Care, 48(S1), S207–S238, 2025.
• DeHaven, M. J., Gimpel, N. A., and Kitzman, H., “Working with communities: Meeting the health needs of those living in vulnerable communities when Primary Health Care and Universal Health Care are not available,” Journal of Evaluation in Clinical Practice, 27(5), 1056–1065, 2021.
• Rodriguez-Galindo, C., “Clinical features and treatment of Langerhans cell histiocytosis,” Acta Paediatrica, 110(11), 2892–2902, 2021.
• Etchegaray, J. M., et al., “Patients as Partners in Learning from Unexpected Events,” Health Services Research, 51(S3), 2600–2614, 2016.
• Schwappach, D. L. B., “Review: Engaging Patients as Vigilant Partners in Safety: A Systematic Review,” Medical Care Research and Review, 67(2), 119–148, 2010.
• Han, J., LaMarra, D., and Vapiwala, N., “Applying lessons from social psychology to transform the culture of error disclosure,” Medical Education, 51(10), 996–1001, 2017.