Fear and secrecy undermine patient safety efforts, Israeli researcher says
Medical errors remain one of the leading causes of death worldwide, rivaling heart disease and cancer, yet healthcare systems continue to struggle to reduce preventable harm according to TPS-IL. A new perspective article by Prof. Mayer Brezis of the Hebrew University of Jerusalem argues that the persistence of medical errors reflects not a lack of medical knowledge, but a systemic failure to confront mistakes openly and learn from them.
Published in the peer-reviewed Risk Management and Healthcare Policy, the article examines why decades of patient safety initiatives have produced only limited results. Prof. Brezis contends that fear of legal consequences, institutional defensiveness and poor communication routinely push healthcare organizations to deny, minimize or conceal errors. This “deny and defend” culture, he argues, prevents meaningful learning and allows the same failures to recur, sometimes with fatal outcomes.
According to the article, communication breakdowns are among the most common causes of medical errors. In many clinical environments, doctors, nurses and technicians hesitate to raise concerns when something appears wrong, fearing blame, retaliation or professional damage. Research from healthcare and other high-risk industries, such as aviation, shows that systems lacking psychological safety are significantly more prone to catastrophic failures.
Brezis illustrates the human cost of this culture through a personal family tragedy. His grandson died after a complex congenital heart defect was missed during a routine pregnancy ultrasound. Only after the child’s death was universal pulse oximetry screening implemented nationally, a reform that has since helped identify similar conditions early and is believed to save dozens of infants each year.
“Mistakes become deadly when systems refuse to learn from them,” Brezis writes, stressing that acknowledging failure is not about assigning blame, but about preventing the next tragedy. Taking responsibility, he argues, is the only way to give meaning to harm that has already occurred.
The article calls for a fundamental shift in how healthcare systems respond when things go wrong. Rather than secrecy and legal defensiveness, Prof. Brezis urges a culture of transparency, humility and open discussion, where errors are disclosed, examined and addressed constructively. Leadership, he emphasizes, plays a decisive role in creating psychological safety and protecting staff who speak up.
Mandatory error disclosure and structured review are central to reducing preventable harm, but only if they are paired with strong psychological safety policies and targeted communication training.
Healthcare organizations must require clinicians to report errors and near-misses promptly, with clear processes for reviewing what went wrong and why, focusing on system failures rather than individual blame. At the same time, staff need explicit protections from retaliation, so that raising concerns is seen as a professional responsibility rather than a personal risk. Communication training should reinforce this culture by improving handoffs, escalation protocols and team-based decision-making, while empowering nurses, residents and other frontline staff to challenge assumptions and speak up when something does not seem right.
Equally critical is leadership accountability for how failures are handled and whether they lead to meaningful change. Senior executives and department heads should be assessed not only on clinical outcomes, but on transparency, follow-through and measurable safety improvements after adverse events. Serious incidents must trigger system-level fixes — such as new screening tools, standardized checklists or revised procedures — instead of being closed quietly through internal reviews or legal settlements.
Legal frameworks also play a role: separating learning and safety investigations from liability processes can reduce defensive behavior and encourage honest analysis. Without leadership commitment and supportive legal structures, disclosure risks becoming a formality rather than a driver of safer care.
Without openness and accountability, Brezis concludes, medical errors will continue to claim lives despite advances in treatment. Learning from failure, he argues, is not optional but essential to saving patients and restoring trust in healthcare.
