Physicians’ Perspectives on Causes of Health Care Errors and Preventive Strategies: A Study in a Developing Country

  • Abbas SHEIKHTAHERI Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran Dept. of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
  • Monireh SADEQI-JABALI Dept. of Health Information Technology, Faculty of Paramedical, Kashan University of Medical Sciences, Kashan, Iran
  • Zahra HASHEMI-DEHAGHI Dept. of Management and Accounting, School of Management, Islamic Azad University, South Tehran Branch, Tehran, Iran Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran
Keywords: Medical error, Healthcare error, Patient safety, Physician


Background: To prevent health care errors, the main causes and preventive strategies should be identified. The purpose of this study was to identify the causes and preventive strategies of health care errors from the perspectives of physicians.Methods: We surveyed 250 randomly selected physicians in five teaching hospitals in Tehran, Iran, in 2015. We used a questionnaire with 29 questions regarding causes and 17 ones regarding the preventive strategies. The participants were asked to answer the questions based on Likert’s five-point score (1=very low to 5= very high). The data was analyzed using descriptive (frequency, and mean scores) and inferential statistics in SPSS.Results: Managerial factors (3.6±0.7), personal factors of providers (3.5±0.6), factors related to the patients (3.4±0.71), and the factors pertinent to laboratory and pharmacy (3.2±0.8) were the main causes respectively. The most important preventive strategies were improvement of academic education, better taking past medical history, implementing electronic prescription and increasing healthcare budget.Conclusion: Heavy workloads, long work shifts, failure to do thorough examination and to collect detailed history information, providers’ fatigue, patients’ reluctance to follow orders or to give their complete information, failure to give detailed instruction to patients about the medications, lack or insufficient monitoring and supervising systems, and lack of enough budget were some of the most important causes of errors. Using IT to access patients’ information, improving patients’ adherence, reducing workload, developing efficient methods for collecting patients’ information, dedicating adequate budget for improvement programs are recommended.  


Sadoughi F, Ahmadi M, Sheikhtaheri A et al (2011). Patient safety information system: purpose, structure and functions. Journal of Mazandaran University of Medical Sciences, 21(85):174-88.

Durmus SÇ, Keçeci A, Akkas Ö et al (2013). Medical errors: an important indicator of quality of care and patient safety. Holist Nurs Pract, 27(4):225-32.

Sheikhtaheri A, Sadoughi F, Ahmadi M et al (2013). A framework of a patient safety information system for Iranian hospitals: lessons learned from Australia, England and the US. Int J Med Inform, 82(5):335-44.

Grober ED, Bohnen JM (2005). Defining medical error. Can J Surg, 48(1):39-44.

Thomas EJ, Studdert DM, Newhouse JP et al (1999). Costs of medical injuries in Utah and Colorado. Inquiry, 36(3):255-64.

Kohn LT, Corrigan JM, Donaldson MS (2000). To err is human: building a Safer health system. National Academies Press, USA.

Lewis PJ, Dornan T, Taylor D et al (2009). Prevalence, incidence and nature of prescribing errors in hospital inpatients. Drug Safe, 32(5):379-89.

Delfan B, Mosadegh A, Nasir Moghadas S et al (2008). Study of medical errors status and its necessity of education from view point of Lorestan general practitioners. Yafteh, 10(1):19-22.

Kavosi Z, Kharazmi E, Sadeghi A et al (2015). Identify pharmaceutical processes potential errors using failure mode and effect analysis. Health Inf Manage, 12(2):228.

Shojania KG, Wald H, Gross R (2002). Understanding medical error and improving patient safety in the inpatient setting. Med Clin North Am,86(4):847-67.

Kingston MJ, Evans SM, Smith BJ, Berry JG (2004). Attitudes of doctors and nurses towards incident reporting: a qualitative analysis. Med J Aust,181(1):36-9.

Mohsenzadeh A, Rezapur T, Birjand M (2009). Prevalence of medical errors in children admitted to the civil martyr Khorramabad first six months of 1387. Proceedings of the Third National Conference on prevention of medical errors, published Negarestan Engineering Company, Lorestan, 74-5.[Persian].

Wong J, Beglaryan H (2004). Strategies for hospitals to improve patient safety: a review of the research. Change Foundation, USA.

Holder RA (2005). Medical errors. Hematology, 1:503-6.

Blendon RJ, DesRoches CM, Brodie M et al (2002). Views of practicing physicians and the public on medical errors. N Engl J Med,347(24):1933-40.

Mahmood A, Chaudhury H, Valente M (2011). Nurses' perceptions of how physical environment affects medication errors in acute care settings. Appl Nurs Res, 24(4):229-37.

Dabaghzadeh F, Rashidian A, Torkamandi H et al (2013). Medication errors in an emergency department in a large teaching hospital in Tehran. Iran J Pharm Res, 12(4):937-942.

Evans J (2009). Prevalence, risk factors, consequences and strategies for reducing medication errors in Australian hospitals: a literature review. Contemp Nurs, 31(2):176-89.

Mansouri A, Ahmadvand A, Hadjibabaie M et al (2014). A review of medication errors in iran: sources, underreporting reasons and preventive measures. Iran J Pharml Res, 13(1):3-17.

McDowell SE, Ferner HS, Ferner RE (2009). The pathophysiology of medication errors: how and where they arise. Br J Clin Pharmacol, 67(6):605-13.

Eslamian J, Taheri F, Bahrami M, Mojdeh S (2010). Assessing the nursing error rate and related factors from the view of nursing staff. Iran J Nur Midwifery Res, 15(Suppl1):272-7.

Harding L, Petrick TR (2008). Nursing student medication errors: a retrospective review. J Nurs Edu,47(1):43-7.

Toruner EK, Uysal G (2012). Causes, reporting, and prevention of medication errors from a pediatric nurse perspective. Australian Journal of Advanced Nursing, 29(4):28-35.

Roy V, Gupta P, Srivastava S (2006). Medication errors: causes & prevention. Health Administrator, 19(1):60-4.Available from: Accessed 20 Feb 2016.

Shahrokhi A, Ebrahimpour F, Ghodousi A (2013). Factors effective on medication errors: A nursing view. J Res Pharm Pract, 2(1):18-23.

Yousefi M, Abed Saeedi Z, Maleki M, Sarbakhsh P (2014). Frequency and causes of medication errors of nurses in different shift works in educational hospitals affiliated to Shahid Beheshti University of Medical Sciences. Advances in Nursing & Midwifery, 24(86):27-34.

Olds DM, Clarke SP (2010). The effect of work hours on adverse events and errors in health care. J Saf Res, 41(2):153-62.

Morris G, Morris R (2000). Anaesthesia and fatigue: an analysis of the first 10 years of the Australian Incident Monitoring Study 1987-1997. Anaesth Intensive Care, 28(3):300-4.

Vidyarthi AR, Auerbach AD, Wachter RM, Katz PP (2007). The impact of duty hours on resident self reports of errors. J Genl Intern Med, 22(2):205-9.

Saremi M, Fallah MR (2013). Subjective fatigue and medical errors among nurses in an educational hospital. Iran Occupational Health Journal, 10(4):1-8.

Gander P, Purnell H, Garden A, Woodward A (2007). Work patterns and fatigue-related risk among junior doctors. Occup Environ Med, 64(11):733-8.

Sedaghat S, Aghababaeian H, Taheri N et al (2012). Study on the level of knowledge and performance of North Khuzestan medical emergency 115 personnel on pre-hospital triage. J Crit Care Nurs, 5(2):103-8.

Hansen M, Meckler G, Dickinson C et al (2015). Children's safety initiative: a national assessment of pediatric educational needs among emergency medical services providers. Prehosp Emerg Care,19(2):287-91.

Mazer M, DeRoos F, Hollander JE et al (2011). Medication history taking in emergency department triage is inaccurate and incomplete. Acad Emerg Med,18(1):102-4.

Hobgood C, Peck CR, Gilbert B et al (2002). Medical errors—what and when: what do patients want to know? Acad Emerg Med,9(11):1156-61.

Sheikhtaheri A, Farzandipour M (2010). Factors associated with quality of informed consent in patients admitted for surgery: an Iranian study. AJOB Primary Research.1(4):9-16.

Sheikhtaheri A, Jabali MS, Dehaghi ZH (2016). Nurses’ knowledge and performance of the patients’ bill of rights. Nursing Ethics, 23(8):866-876.

Wagner PJ, Moseley GC, Grant MM, Gore JR, Owens C (2002). Physicians' emotional intelligence and patient satisfaction. Fam Med,34(10):750-4.

Khademolhoseini Z, Khademolhoseini M, Mahmoodian F (2011). Ethical and behaviral roles of physicians and its effects on patients adherence to physician's orders in treatment process. Medical Ethics, 3(8):91-101. [Persian].

Farzandipour M, Meidani Z, Riazi H, SadeqiJabali M (2013). Requirements for improving health quality and safety in hospital information systems. Health Info Manage, 11(3):293-307.

Chan DS, Callahan CW, Hatch-Pigott VB et al (2007). Internet-based home monitoring and education of children with asthma is comparable to ideal office-based care: results of a 1-year asthma in-home monitoring trial. Pediatrics, 119(3):569-578.

Alsulami Z, Conroy S, Choonara I (2013). Medication errors in the Middle East countries: a systematic review of the literature. Eur J Clin Pharmacol, 69(4):995-1008.

Al-Saleh KS, Ramadan MZ (2012). Studying medical errors among hospital-staff at saudi health providers. J Mater Sci Eng, 2(1):43-54.

Grandell-Niemi H, Hupli M, Puukka P, Leino-Kilpi H (2006). Finnish nurses’ and nursing students’ mathematical skills. Nurse Edu Today, 26(2):151-61.

Coombs J (2001). Quality of care in rural settings: bringing the “New Quality” to rural practice. Textbook of rural medicine. New York: McGraw-Hill. pp. 325-40.

Reason J (2000). Human error: models and management. BMJ, 320(7237):768–70.

Sheikhtaheri A (2014). Near misses and their importance for improving patient safety. Iran J Public Health,43(6):853-4.

Farzandipour M, Sheikhtaheri A (2009). Evaluation of factors influencing accuracy of principal procedure coding based on ICD-9-CM: an Iranian study. Perspect Health Inf Manage, 7:6:5.

How to Cite
SHEIKHTAHERI A, SADEQI-JABALI M, HASHEMI-DEHAGHI Z. Physicians’ Perspectives on Causes of Health Care Errors and Preventive Strategies: A Study in a Developing Country. IJPH. 47(5):720-8.
Original Article(s)