Managing Medical Errors in a University Hospital: How to Handle the Internal Learning–External Protection Paradox?

  • Julien Cusin IAE Bordeaux – Université de Bordeaux, IRGO, Bordeaux, France
  • Anne Goujon-Belghit Université de Bordeaux
Keywords: erreur médicale, paradoxe, apprentissage, protection, communication ouverte, communication défensive


Hospitals are looking to strengthen their safety culture by learning internally from medical errors that occur to prevent them from happening again. This implies creating an atmosphere of psychological safety that encourages errors to be reported. Only open communication from teams can help to improve practices. Also, many establishments have implemented no-punishment charters, creating a policy of tolerance of errors. However, a medical error can become a legal issue. The fact that a court of law can use anything hospital staff have said or written after an adverse event has occurred encourages defensive communication to protect oneself from outside stakeholders. To date, the literature on medical errors has not studied how hospitals overcome this contradiction. In this qualitative research, we use paradox theory in the case of a single university hospital to understand how a hospital confronted with medical errors can effectively manage the internal learning–external protection paradox. A deeper study of this specific context also allows us to supplement the literature on organizational paradoxes. We demonstrate how the interactions between different levels of analysis contribute to operationalizing paradox management in a dynamic and characteristic way, on the one hand, and what makes it effective, on the other hand.


Download data is not yet available.


Amalberti, R., Bruneau, C., Desplanques, A. & Degos, L. (2009). Viewing the safety imperative from the French policy perspective. Quality & Safety in Health Care, 18(6), 420–421. doi: 10.1136/qshc.2009.037036

Andriopoulos, C. & Gotsi, M. (2017). Methods of paradox. In W. Smith, M. Lewis, P. Jarzabkowski, & A. Langley (Eds.), The Oxford handbook of organizational paradox (pp. 513–527). Oxford University Press. doi: 10.1093/oxfordhb/9780198754428.013.26

Argyris, C. (1986). Reinforcing organizational defensive routines: An unintended human resources activity. Human Resource Management, 25(4), 541–555. doi: 10.1002/hrm.3930250405

Barbot, J. & Fillion, E. (2006). La ‘médecine défensive’: critique d’un concept à succès. Sciences Sociales et Santé, 24(2), 5–33. doi: 10.3917/sss.242.0005

Bernard-Weil, E. (2003). Stratégies paradoxales en bio-médecine et sciences humaines. L’Harmattan.

Cameron, K. & Quinn, R. (1988). Organizational paradox and transformation. In R. Quinn & K. Cameron (Eds.), Paradox and transformation (pp. 1–18). Ballinger Publishing Company.

Cohen, M., March, J. & Olsen, J. (1972). A garbage can model of organizational choice. Administrative Science Quarterly, 17(1), 1–25. doi.10.2307/2392088

Cwiek, M., Kikano, G., Novaretti, M. & Klaus, J. (2018). International implications of open disclosure of medical errors, and the superiority of full risk integration. Journal of Global Business and Technology, 14(2), 1–14.

Dahlin, K., Chuang, Y.-T. & Roulet, T. (2018). Opportunity, motivation, and ability to learn from failures and errors: Review, synthesis, and ways to move forward. Academy of Management Annals, 12(1), 252–277. doi: 10.5465/annals.2016.0049

Dekker, S. (2013). Second victim: Error, guilt, trauma, and resilience. CRC Press.

Dimitrova, N., Van Hooft, E., Van Dyck, C. & Groenewegen, P. (2017). Behind the wheel: What drives the effects of error handling? The Journal of Social Psychology, 157(6), 658–672. doi: 10.1080/00224545.2016.1270891

Dittrich, K., Jaspers, F., Van der Valk, W. & Wynstra, F. (2006). Dealing with dualities. Industrial Marketing Management, 35(7), 792–796. doi: 10.1016/j.indmarman.2006.07.001

DREES. (2011). Enquête nationale sur les événements indésirables graves associés aux soins – Description des résultats 2009. Document de travail, Série Études et Recherche, 110, 1–212.

Frese, M. & Keith, N. (2015). Action errors, error management and learning in organizations. Annual Review of Psychology, 66(1), 661–687. doi: 10.1146/annurev-psych-010814-015205

Giordano, Y. (2003). Les paradoxes: Une perspective communicationnelle. In V. Perret & E. Josserand (Eds.), Le paradoxe: Penser et gérer autrement les organisations (pp. 115–128). Ellipses.

Goodman, P., Ramanujam, R., Carroll, J., Edmondson, A., Hofmann, D. & Sutcliffe, K. (2011). Organizational errors: Directions for future research. Research in Organizational Behavior, 31, 151–176. doi: 10.1016/j.riob.2011.09.003

Grimand, A., Oiry, E. & Ragaigne, A. (2018). Les paradoxes organisationnels et le déploiement des outils de gestion: leçons issues de deux études de cas. Finance Contrôle Stratégie, 21(3), 1–26. doi: 10.4000/fcs.2890

Grimand, A., Vandangeon Derumez, I. & Schäfer, P. (2014). Manager les paradoxes de la RSE. Le déploiement de la norme ISO 26000 dans une ETI. Revue Française de Gestion, 240(3), 133–148. doi: 10.3166/RFG.240.133-148

Gronewold, U., Gold, A. & Salterio, S. (2013). Reporting self-made errors: The impact of organizational error-management climate and error type Journal of Business Ethics, 117(1), 189–208. doi: 10.1007/s10551-012-1500-6

Jarzabkowski, P. & Lê, J. (2017). We have to do this and that? You must be joking: Constructing and responding to paradox through humor. Organization Studies, 38(3–4), 433–462. doi: 10.1177/0170840616640846

Journé, B. (2003). Les paradoxes de la gestion de la sûreté nucléaire. In V. Perret & E. Josserand (Eds.), Le paradoxe : Penser et gérer autrement les organisations (pp. 223–252). Ellipses.

Kalra, J., Kalra, N. & Baniak, N. (2013). Medical error, disclosure and patient safety: A global view of quality care. Clinical Biochemistry, 46(13–14), 1161–1169. doi: 10.1016/j.clinbiochem.2013.03.025

Khatri, N., Brown, G. & Hicks, L. (2009). From a blame culture to a just culture in health care. Health Care Management Review, 34(4), 312–322. doi: 10.1097/HMR.0b013e3181a3b709

Latil, F., De Boer, W. & Cardona, J. (2008). Pour une maîtrise médicalisée des préjudices liés aux soins. Pratiques et Organisations des Soins, 39(4), 331–339. doi: 10.3917/pos.394.0331

Laude, A. (2013). La judiciarisation de la santé, Questions de santé publique, 20, 1–4.

Lewis, M. (2000). Exploring paradox: Toward a more comprehensive guide. Academy of Management Review, 25(4), 760–776. doi: 10.5465/amr.2000.3707712

Lüscher, L. & Lewis, M. (2008). Organizational change and managerial sensemaking: Working through paradox. Academy of Management Journal, 51(2), 221–240. doi: 10.5465/amj.2008.31767217

Miron-Spektor, E., Ingram, A., Keller, J., Smith, W. & Lewis, M. (2018). Microfoundations of organizational paradox: The problem is how we think about the problem. Academy of Management Journal, 61(1), 26–45. doi: 10.5465/amj.2016.0594

Patton M. (2002). Qualitative research and evaluation methods (3rd ed.). Sage.

Pellerin, D. (2008). Les erreurs médicales. Les Tribunes de la Santé, 3(20), 45–56. doi: 10.3917/seve.020.0045

Perret, V. & Josserand, E. (2003). La valeur heuristique du paradoxe pour les sciences de l’organisation. In V. Perret & E. Josserand (Eds.), Le paradoxe: Penser et gérer autrement les organisations (pp. 5–22). Ellipses.

Poole, M. & Van de Ven, A. (1989). Using paradox to build management and organizational theory. Academy of Management Review, 14(4), 562–578. doi: 10.2307/258559

Putnam, L., Fairhurst, G. & Banghart, S. (2016). Contradictions, dialectics, and paradoxes in organizations: A constitutive approach. Academy of Management Annals, 10(1), 65–171. doi: 10.1080/19416520.2016.1162421

Rathert, C. & Phillips, W. (2010). Medical error disclosure training: Evidence for values-based ethical environments. Journal of Business Ethics, 97(3), 491–503. doi: 10.1007/s10551-010-0520-3

Rothenberg, A. (1979). The emerging goddess. University of Chicago Press.

Saintoyant, V., Duhamel, G. & Minvielle, E. (2012). Gestion des risques associés aux soins: état des lieux et perspectives. Pratiques et Organisation des Soins, 43(1), 35–45. doi: 10.3917/pos.431.0035

Schad, J., Lewis, M., Raisch, S. & Smith, W. (2016). Paradox research in management science: Looking back to move forward. Academy of Management Annals, 10(1), 5–64. doi: 10.5465/19416520.2016.1162422

Smith, W. & Lewis, M. (2011). Toward a theory of paradox: A dynamic equilibrium model of organizing. Academy of Management Review, 36(2), 381–403. doi: 10.5465/amr.2009.0223

Valette, A., Fatien Diochon, P. & Burellier, F. (2018). A chacun son paradoxe: Etude de la délégation des paradoxes organisationnels aux individus. Revue Française de Gestion, 270(1), 115–126. doi: 10.3166/rfg.2017.00169

Vogus, T., Sutcliffe, K. & Weick, K. (2010). Doing no harm: Enabling, enacting, and elaborating a culture of safety in health care. Academy of Management Perspectives, 24(4), 60–77. doi: 10.2139/ssrn.1904620

Vrbnjak, D., Denieffe, S., O’Gorman, C. & Pajnkihar, M. (2016). Barriers to reporting medication errors and near misses among nurses: A systematic review. International Journal of Nursing Studies, 63, 162–178. doi: 10.1016/j.ijnurstu.2016.08.019

Waldman, D., Putnam, L., Miron-Spektor, E. & Siegel, D. (2019). The role of paradox theory in decision making and management research. Organizational Behavior and Human Decision Processes, 155, 1–6. doi: 10.1016/j.obhdp.2019.04.006

Weinberg, J. (2002). Medical error and patient safety: Understanding cultures in conflict. Law & Policy, 24(2), 93–113. doi: 10.1111/1467-9930.00129

World Health Organization. (2011). Patient safety curriculum guide – Multi-professional Edition, pp. 1–270.

Zhao, B. & Olivera, F. (2006). Error reporting in organizations. Academy of Management Review, 31(4), 1012–1030. doi: 10.5465/amr.2006.22528167

How to Cite
Cusin J., & Goujon-Belghit A. (2022). Managing Medical Errors in a University Hospital: How to Handle the Internal Learning–External Protection Paradox?. M@n@gement, 25(1), 15–32.
Original Research Articles