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In May, 2016, the British Medical Journal raised serious concerns among patients and physicians when it published a study that found that medical errors are the third leading cause of death in the United States. The authors of the study attributed the alarming number of deaths caused by medical errors to a lack of reporting protocols in hospitals that could be used to correct problems and prevent future errors. Since the study was released, medical professionals have engaged in a heated debate as to what can be done to curb this troubling trend. One idea involves creating disincentives in the form of stiff penalties and publically-published records of hospitals and physicians who are prone to committing medical errors. It might seem like a reasonable solution to the problem, but in fact it’s already been tested in one state with decidedly mixed results.

Since 2007, the state of California has issued $17 million in fines and publicly shamed 192 hospitals for committing severe yet preventable medical errors. Not all errors are released to the public – only those that constitute “immediate jeopardy incidents” which can cause serious injury or death to a patient. California’s penalty system is currently the only one of its kind in the country. But after nine years of penalizing medical facilities for committing these dangerous errors, data analysists at the San Diego Union-Tribune found that the number of medical errors in California is actually higher today than when the program began in 2007. While certain types of medical errors – hospital-acquired infections, for example – have declined in recent years, others have continued to rise. This has left legislators and medical professionals in California to wonder what else can be done to reduce the rate of deadly medical errors in the state.

The general consensus seems to be that transparency is key. In order for hospitals to effectively correct dangerous trends in medical errors, they first need to be able to identify the sources of those trends. Increased transparency can also provide physicians and medical facilities with the opportunity to learn from one another’s mistakes.

If California’s program can teach us anything, it’s that stiff penalties alone are unlikely to cause a significant, long-term decline in deadly medical errors. Rather, it will take a number of different types of reform to make a meaningful impact on high medical error rates.