People go to hospitals to be treated for an illness or for corrective surgery with the expectation they will return home in much better health than when they entered the medical facility.

The reality, though, is that many may never recover or return home. A 2009 study by Hearst newspapers estimated the death toll from preventable medical mistakes is nearly 200,000 annually in the U.S.

That's not much different than a 2004 report from HealthGrades, a health-care quality organization, showing that in the three previous years, about 195,000 Americans died each year as a result of preventable medical practices in hospitals.

One way of lowering those numbers is to reform the way errors are reported, which in this country is often beset by complex and contentious procedures, according to the reports.

Improvements in hospital safety practices begin with the reporting of errors and potential mistakes in the care of patients, says Dana E. Sims, who focused a study on the influence of a learning orientation culture within an organization and trust in leadership on workers' willingness to formally report and document errors.

Sims, who conducted the study for doctoral dissertation at the University of Central Florida in 2009, presented her findings last month at the Society for Industrial and Organizational Psychology's annual conference in Atlanta.

There is no uniform reporting among states in regard to releasing information about mistakes. In March, the Inspector General of the Department of Health and Human Services issued a report that indicated hospitals aren't consistent in gathering information about preventable medical errors because of inadequate hospital data and poor internal tracking of medical errors by hospitals themselves.

Accurate reporting of errors depends upon whether organizations encourage, support, and follow up on the documentation of errors and practices that can harm patients, researchers say. Also, compiling information relies heavily on front-line employees, nurses, and medical staff being able to report mistakes within a nonthreatening culture, they say.

"It's important to identify and adapt procedures that are unsafe and potentially can lead to serious mistakes," says Sims. "If hospital administrators are unaware of mistakes and unsafe practices, they cannot do anything about them."

Too often health-care workers believe error reporting is a sure path to trouble that will result in blame and punishment to those involved. On the other hand, some hospitals will avoid finger-pointing and instead take a holistic view of where the systemic failure might have occurred, says Sims.

Her study of care units within two hospitals found that organizations and leaders who promote a "learn from our mistakes" culture might bolster employees' decisions to discuss errors openly.

"A smart organization knows that employees are aware of practices and incidents on the front line that the administration does not want to hear. But the administration needs to encourage employees to report them anyway to avert disaster," Sims says.

Sometimes top leaders are too insulated from what is happening within the organization, she adds.

"In the long term, hearing what employees have to say can save lives as well as prevent expensive lawsuits and damage to a hospital's reputation," she says.

She found that perceptions about the organization are the strongest predictor of whether employees tend to document errors.

Establishing an organizational learning climate is important to sound reporting practices, says Sims. An organizational climate is a shared perception by workers of what is valued and expected in the work environment based upon the norms, policies, and procedures set by the organization.

Without those organizational standards, teams tend to make excuses, become defensive, and punish and blame others. Instead, an environment should be promoted where mistakes are viewed as an opportunity to improve team performances and openly discuss errors and potential mistakes, she says.

The most common hospital mistakes are shortcuts or work-arounds that medical staffs use in an effort to be more efficient in their work. Some of these basic at-risk behaviors could include failure to properly identify patients or to verify prescription dosages and inaccurate documentation of vitals, Sims says.

These often are done by experienced nurses who have handled these kinds of tasks previously and are convinced that a shortcut is acceptable, but in most cases it's not the right thing to do, she asserts.

"Human mistakes are different than reckless practices," Sims says. "Sometimes in health care, with its accompanying stresses, there is a propensity to work around procedures in an effort to be more efficient. Rules and procedures are there for a reason and are intended to increase patient safety."

She adds, "Individuals have a personal responsibility when they engage in those work-arounds. While the organization needs to make clear that they are also accountable for reckless behavior, it also needs to identify internal practices that might be encouraging those work-arounds to be used."

Hospitals can benefit by supporting employees who report practices that can lead to serious errors and using those reports to improve procedures.

Providing good coaching and mentoring and making system changes will make a difference, Sims says. One surprise Sims found in her study was a difference between an organizational-directed learning environment and a leader-promoted environment. Leaders, says Sims, are those people responsible for units within the organization.

"Based upon past research, I didn't expect there to be much difference between perceptions of the leader and the organization, but the nurses I talked with said there often is a difference," Sims says. "Unit leaders have varying leadership styles and the way they interpret or put into practice organizational policies and procedures. Some are unwavering in following the procedures while others are more relaxed. In short, some filter the organizational policies."

"Health-care organizations should place increased emphasis on what is done with the information gathered from error-reporting systems," Sims' study concluded.

"Specifically, organizations must ensure that employees know they are being heard, that systemic problems identified via error reporting are addressed by the organization, and that employees who admit to and/or identify errors are helping the organization to create a climate of safer medical care," she says.

Further, leaders at the point of care play an important role in their team's willingness to document errors. Organizations must ensure their leaders have the skills necessary to reinforce learning-oriented responses to errors within their units, Sims says.

Without such changes, needless, avoidable deaths won't diminish in the nation's hospitals and care facilities, she contends.