Factors contributing to under-reporting of patient safety incidents in Indonesia: leaders’ perspectives

Abstract

Background: Understanding the causes of patient safety incidents is essential for improving patient safety; therefore, reporting and analysis of these incidents is a key imperative. Despite its implemention more than 15 years ago, the institutionalization of incident reporting in Indonesian hospitals is far from satisfactory. The aim of this study was to analyze the factors responsible for under-reporting of patient safety incidents in Indonesian public hospitals from the perspectives of leaders of hospitals, government departments, and independent institutions. Methods: A qualitative research methodology was adopted for this study using semi-structured interviews of key informants. 25 participants working at nine organizations (government departments, independent institutions, and public hospitals) were interviewed. The interview transcripts were analyzed using a deductive analytic approach. Nvivo 10 was used to for data processing prior to thematic analysis. Results: The key factors contributing to the under-reporting of patient safety incidents were categorized as hospital related and nonhospital related (government or independent agency). The hospital-related factors were: lack of understanding, knowledge, and responsibility for reporting; lack of leadership and institutional culture of reporting incidents; perception of reporting as an additional burden. The nonhospital-related factors were: lack of feedback and training; lack of confidentiality mechanisms in the system; absence of policy safeguards to prevent any punitive measures against the reporting hospital; lack of leadership. Conclusion: Our study identified factors contributing to the under-reporting of patient safety incidents in Indonesia. The lack of government support and absence of political will to improve patient safety incident reporting appear to be the root causes of under-reporting. Our findings call for concerted efforts involving government, independent agencies, hospitals, and other stakeholders for instituting reforms in the patient safety incident reporting system.

A qualitative study of the reasons for low patient safety incident reporting among Indonesian nurses

“…This finding was consistent with a previous study that found that despite knowing about a reporting system in their hospital, staff did not know how to access an incident form or what to do with it once completed ( 34 ) . A previous study in Indonesia with similar findings highlighted a lack of knowledge and understanding regarding incident reporting ( 14 ) . A previous study identified three crucial phases of incident reporting: awareness and knowledge of the system, the ability to recognize reportable incidents, and the capacity to overcome any reporting barriers ( 35 ) .…”

“…Fear of being blamed or punished has also been identified as a significant cultural barrier ( 16 , 40 ) . A positive culture is required to raise individuals’ awareness of incident reporting ( 14 ) . Therefore, improving patient safety culture may also improve nurses’ attitudes towards incident reporting ( 13 ) .…”

“…A further factor contributing to the system’s success is the leader’s commitment to reporting patient safety incidents. A previous study found that patient safety incidents underreporting in Indonesia was primarily due to a lack of hospital-level leadership and feedback ( 14 ) . Moreover, Indonesia has done little to document the lessons learned from national patient safety incident reporting or its potential to enhance patient outcomes or care procedures ( 16 ) .…”

“…Several factors, including nurses’ reluctance to report for fear of punishment, lack of knowledge, greater emphasis on severe accidents ( 10 ) , inadequate reporting systems, management behavior, unclear definition of incidents, and fear of lawsuits, prevent the reporting process for patient safety from being optimally carried out ( 11 ) . Other studies have found that some factors like gender, marital status ( 12 ) , patient safety culture, nurses’ attitudes ( 13 ) , lack of government support, and political will ( 14 ) can also influence patient safety incident reporting.…”

Safety Incidents in Psychiatric Inpatient Care: A Qualitative Content Analysis of Safety Incident Reports

“…In our data, systematic reporting, going through the incidents in ward meetings, and informing management were such practices. Our positive fnding was that staf is reporting the incidents, which is not always self-evident or daily practice at the hospital level [28]. Fear of consequences and inefective systems are central examples that may cause underreporting of incidents [29].…”