Why do some hospital leaders “speak no evil” about their organizations' medical errors?

Sentinel events, preventable medical errors resulting in serious disability or death, are a significant problem for hospital leaders. Accreditation agencies, such as the Joint Commission, urge hospitals to voluntarily disclose information about medical errors. However, some healthcare leaders “speak no evil” by choosing not to release sentinel-event data. In an effort to increase the reporting of medical errors, several states passed laws mandating disclosure of sentinel events to the government. The state-reported medical error rates of Indiana hospitals were compared with their leaders' perceptions of quality of care. Regardless of the number of sentinel events occurring at their hospitals, leaders consistently claimed their organizations provided high-quality care. Two theories, rationalization and gaming, are presented to explain why leaders do not acknowledge the presence of serious quality-management problems in their organizations.