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Patient Error: A Preliminary Taxonomy

¹ Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
² Department of Social and Community Health, University of Auckland, Auckland, New Zealand
³ Department of General Practice, University of Otago, Dunedin, New Zealand
⁴ Department of Primary Care and Public Health, Cardiff University, Wales

CORRESPONDING AUTHOR: Stephen Buetow, PhD, Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand, s.buetow{at}auckland.ac.nz

PURPOSE Current research on errors in health care focuses almost exclusively on system and clinician error. It tends to exclude how patients may create errors that influence their health. We aimed to identify the types of errors that patients can contribute and help manage, especially in primary care.

METHODS Eleven nominal group interviews of patients and primary health care professionals were held in Auckland, New Zealand, during late 2007. Group members reported and helped to classify types of potential error by patients. We synthesized the ideas that emerged from the nominal groups into a taxonomy of patient error.

RESULTS Our taxonomy is a 3-level system encompassing 70 potential types of patient error. The first level classifies 8 categories of error into 2 main groups: action errors and mental errors. The action errors, which result in part or whole from patient behavior, are attendance errors, assertion errors, and adherence errors. The mental errors, which are errors in patient thought processes, comprise memory errors, mindfulness errors, misjudgments, and—more distally—knowledge deficits and attitudes not conducive to health.

CONCLUSION The taxonomy is an early attempt to understand and recognize how patients may err and what clinicians should aim to influence so they can help patients act safely. This approach begins to balance perspectives on error but requires further research. There is a need to move beyond seeing patient, clinician, and system errors as separate categories of error. An important next step may be research that attempts to understand how patients, clinicians, and systems interact to cocreate and reduce errors.

Key Words: Safety • classification • patients • primary health care

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