Disclosure of adverse outcomes in medicine: A questionnaire study on voice intention and behaviour of physicians in Germany,Japan and the USA

This study contributes to a better understanding of the determinants of voice expressed by physicians in different cultural settings. Voice, captured as disclosure of adverse outcomes and medical errors, is regarded as important for the reduction of the high rate of adverse events in medicine as compared to other high-risk professions. Within a cross-sectional, cross-cultural questionnaire study we explored the impact of selected individual, situational and organisational determinants for disclosure intention, and the behaviour of 251 physicians at three university hospitals in Germany, Japan and the USA. We found disclosure intention to be the lowest in Japan, while no cross-cultural differences existed for disclosure behaviour. Logistic regression analyses showed that culture moderated the effect of disclosure intention on behaviour. Only in Japan was disclosure behaviour a function of the level of disclosure intention. A written mistake disclosure policy encouraged voice behaviour, while internal attribution of medical errors and paternalism discouraged it.