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– MINNESOTA –
Public and Private Policy
Medical Errors and Patient Safety

Rationale

The Minnesota Adverse Health Care Event Act does not provide the rationale or the reason for the adverse event reporting law. However, the MHA does provide background information in its December 2004 document [PDF].

“The existing law – the Vulnerable Adult Act – had provisions that were very unclear, definitions are ambiguous, and the type of incidents required to be reported vary based on whom you ask. To advance the culture of patient safety, the Minnesota Hospital Association (MHA), the Minnesota Alliance for Patient Safety (MAPS), and others realized there must be a mechanism in place to support and encourage health care providers to recognize, report, and learn from adverse health events. The Vulnerable Adult Act was punitive in nature and discouraged caregivers from reporting due to peer pressure, and worse yet, they are fearful of losing their license to care for patients.”

“The goal of developing a new system was to create a mechanism to learn and prevent harm to patients . . ”

In creating its new law on adverse event reporting, Minnesota selected 27 very specific and clear, nationally-standardized, serious reportable events advocated by the NQF [see DefinitionsPDF]. This new law focused on learning what went wrong, not whom to blame. According to the provisions of the law, each hospital and outpatient surgical center (after revisions to the original legislation in 2004) is held accountable for reporting, developing and implementing a corrective action plan to prevent reoccurrence of adverse events.

It is apparent that support for the legislation was broad-based with endorsement by the Minnesota Department of Health (MDH), the Minnesota Nurses Association (MNA), the Minnesota Medical Association (MMA), and the Minnesota Hospital Association (MHA), which made it a priority legislation in 2003. In addition, support from the statewide safety coalition of over 50 health care organizations, the Minnesota Alliance for Patient Safety (MAPS), helped build interest in the idea when it commissioned a task force to begin looking at ways to decrease the punitive nature and the ambiguity of the current law.

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