Attitudes of doctors and nurses towards incident reporting: a qualitative analysis

Abstract

Objectives: (i) To examine attitudes of medical and nursing staff towards reporting incidents (adverse events and near‐misses), and (ii) to identify measures to facilitate incident reporting. Design: Qualitative study. In March 2002, semistructured questions were administered to five focus groups — one each for consultants, registrars, resident medical officers, senior nurses, and junior nurses. Participants and setting: 14 medical and 19 nursing staff recruited using purposive sampling from three metropolitan public hospitals in Adelaide, South Australia. Main outcome measures: Attitudes and barriers to incident reporting; differences in reporting behaviour between disciplines; how to facilitate incident reporting. Results: Cultural differences between doctors and nurses, identified using Triandis’ theory of social behaviour, were found to underpin attitudes to incident reporting. Nurses reported more habitually than doctors due to a culture which provided directives, protocols and the notion of security, whereas the medical culture was less transparent, favoured dealing with incidents “in‐house” and was less reliant on directives. Common barriers to reporting incidents included time constraints, unsatisfactory processes, deficiencies in knowledge, cultural norms, inadequate feedback, beliefs about risk, and a perceived lack of value in the process. Conclusions: Strategies to improve incident reporting must address cultural issues.

Conceptualising barriers to incident reporting: a psychological framework

“…For example, there is still a lack of theory-based evidence on professional differences in IRS use 13 27 37. In an empirical study based on the proposed framework, multigroup analyses (in a structural equation model) will show whether there are motivational differences between groups of clinicians and whether different factors will enhance or reduce the willingness to report for physicians and nurses, respectively.…”

“…IRS characteristics assumed to be relevant are degree of anonymity or confidentiality,52 53 the reporting form (eg, paper based vs electronic),33 35 37 the process for analysing incidents (eg, within hospital vs external experts),43 the definition and classification of incidents to be reported,40 and the feedback process on incidents reported and measures taken to prevent reoccurrence 34 39. According to the investigation of differences between professional groups, a cross-sectional study comparing hospitals using IRS that vary on the above-described dimensions will shed light onto the influences that the IRS itself has on the concepts of the framework and their interrelations.…”

Trends in healthcare incident reporting and relationship to safety and quality data in acute hospitals: results from the National Reporting and Learning System

“…Many incidents still go unreported, with doctors being less likely than nurses to report 10 11. Barriers to reporting include time constraints, lack of knowledge about how and what to report, fear of blame, lack of feedback and a perceived lack of value in the reporting process 11 – 13.…”

Patient safety incidents associated with obesity: a review of reports to the National Patient Safety Agency and recommendations for hospital practice

“…Previously published work has shown that in most incident reporting systems the majority of incidents are reported by nursing staff 8 22 23. This is reflected in our search by the large number of reports referring to infrastructure and equipment rather than assessment, diagnosis or treatment.…”

“…Many incidents are not reported or are incomplete as they are reported immediately, often before patient outcome is known. Under reporting occurs frequently because incidents may be perceived as being so common as not to be felt worth reporting 8 9. Staff may also fear the consequences of reporting despite efforts to make the process of reporting more transparent.…”