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When looking at your reporting system, one of the key factors to understand is not so much what your rate is, but more importantly, what is your under-reporting rate? That’s the specific piece of data that allows you to really start understanding your system. So, if you have 10 events per month, then you must make some assessment about whether that’s a picture of the reality or just a partial view. Understanding the under-reporting rate helps us get to a point where we might start seeing the reality of our system and allows us to have some intellectual honesty about it.
For example, the Institute for Safe Medication Practices has done some phenomenal work, and in some of their studies they estimated that 90% of medication errors are under-reported. So, if we walk in and we see that we are having 10 events per month, then we can make an assumption if we look at the 90% rule that we might actually have 100 events per month. Now, why do we have that 100? And with that knowledge of our under-reporting, we could make a better assessment of what our system risk is and why we are obtaining 100 events per month and not live with the sense of false security of only having 10 events per month.
John Westphal discusses under reporting in the video below.