Managing Medical Errors in a University Hospital: How to Handle the Internal Learning–External Protection Paradox?

Hospitals are looking to strengthen their safety culture by learning internally from medical errors that occur to prevent them from happening again. This implies creating an atmosphere of psychological safety that encourages errors to be reported. Only open communication from teams can help to improve practices. Also, many establishments have implemented no-punishment charters, creating a policy of tolerance of errors. However, a medical error can become a legal issue. The fact that a court of law can use anything hospital staff have said or written after an adverse event has occurred encourages defensive communication to protect oneself from outside stakeholders. To date, the literature on medical errors has not studied how hospitals overcome this contradiction. In this qualitative research, we use paradox theory in the case of a single university hospital to understand how a hospital confronted with medical errors can effectively manage the internal learning–external protection paradox. A deeper study of this specific context also allows us to supplement the literature on organizational paradoxes. We demonstrate how the interactions between different levels of analysis contribute to operationalizing paradox management in a dynamic and characteristic way, on the one hand, and what makes it effective, on the other hand.