Show Me the Money, I'll Show You My Complications: Impacts of Incentivized Incident Self-Reporting Among Surgeons

Sharma Cook-Richardson, Alex Addo, Paul Kim, Justin Turcotte, Adrian Park

Research output: Contribution to journalArticlepeer-review


Introduction: Trial and error have the propensity to generate knowledge. Near misses and adverse event reporting can improve patient care. Professional ridicule or litigation risks after an incident may lead to decreased reporting by physicians; however, the lack of incident reporting can negatively affect patient safety and halt scientific advancements. This study compares reporting patterns after distribution of financial incentives to surgeons for self-reporting quality incidents. Methods: Retrospective review of an internal incident reporting system, RL6, from September 2018 to September 2019 was performed. Incident reporting patterns after incentive distributions across professional classifications and surgical specialties were evaluated. Engagement surveys on incident reporting were completed by physicians. The primary outcomes were changes in reporting patterns and perceptions after distribution of incentives. Results: Two hundred and eighteen surgical patients were identified in the incidents reported. Financial incentives significantly increased incidents reported (35 to 183) by physicians (37.1% to 67.8%; P < 0.001) and physician assistants (2.9% to 18.6%; P < 0.001). Acute care surgery displayed the largest increase in incidents reported among surgical specialties (5.7% to 20.2%; P = 0.040). Surgeons exhibited an increase in reporting (60.0% to 94.5%; P < 0.001) compared with witnesses after incentivization (2.9% to 1.6%). Conclusions: Financial incentives were associated with increased incident reporting. After the establishment of incentives, physicians were more likely to report their incidents, which may dispel professional embarrassment and display incident ownership. Institutions must encourage reporting while supporting providers. Future quality-improvement studies targeting reporting should incorporate incentives aimed to engage and empower health-care providers.

Original languageEnglish (US)
Pages (from-to)136-144
Number of pages9
JournalJournal of Surgical Research
StatePublished - Jun 2022
Externally publishedYes


  • Acute Care Surgery (ACS)
  • American Society of Anesthesiologists (ASA)
  • Incentivization
  • Minimally Invasive Surgery (MIS)
  • Otolaryngologist (ENT)
  • Post-Graduate Year (PGY)
  • Post-incentive distribution (Post)
  • Pre-incentive distribution (Pre)
  • Venous Thromboembolism (VTE)

ASJC Scopus subject areas

  • Surgery


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