Angood says the fear of retaliation is also rooted in the traditional risk management models that hospitals have used for years.
"Risk management programs in hospitals historically have been oriented to protect the hospital from legal action. So in many places, not all, there is a fear from the administration and the risk management offices of receiving reports because it becomes discoverable information and the potential for legal liability," he says.
"Once that tone is set it doesn't take much for the workforce to recognize that reporting can be harmful for the institution. So they won't report."
Angood believes the fear of retaliation will wane in the long run as more physicians become hospital employees, "but we will probably go through a little dip and then move on to a projection of improvement."
"That dip will occur because the existing physician workforce and many in the non-physicians workforce are caught in the trap of fear of reporting and the pressure for models of care change," he says.
"As employed physicians get used to that, there will be an increased level of education and awareness on the benefits of tackling errors and safety problems head on with improved reporting. Other industries have recognized that good reporting strategy leads to improvements in quality and safety and employed physicians will gradually bring that forward in healthcare systems."