Nationwide survey on Japanese residents’ experience with and barriers to incident reporting

Abstract

The ability of any incident reporting system to improve patient care is dependent upon robust reporting practices. However, under-reporting is still a problem worldwide. We aimed to reveal the barriers experienced while reporting an incident through a nationwide survey in Japan. We conducted a cross-sectional survey. All first- and second-year residents who took the General Medicine In-Training Examination (GM-ITE) from February to March 2021 in Japan were selected for the study. The voluntary questionnaire asked participants regarding the number of safety incidents encountered and reported within the previous year and the barriers to reporting incidents. Demographics were obtained from the GM-ITE. The answers of respondents who indicated they had never previously reported an incident (non-reporting group) were compared to those of respondents who had reported at least one incident in the previous year (reporting group). Of 5810 respondents, the vast majority indicated they had encountered at least one safety incident in the past year (n = 4449, 76.5%). However, only 2724 (46.9%) had submitted an incident report. Under-reporting (more safety incidents compared to the number of reports) was evident in 1523 (26.2%) respondents. The most frequently mentioned barrier to reporting an incident was the time required to file the report (n = 2622, 45.1%). The barriers to incident reporting were significantly different between resident physicians who had previously reported and those who had never previously reported an incident. Our study revealed that resident physicians in Japan commonly encounter patient safety incidents but under-report them. Numerous perceived and experienced barriers to reporting remain, which should be addressed if incident reporting systems are to have an optimal impact on improving patient safety. Incident reporting is essential for improving patient safety in an institution, and this study recommends establishing appropriate interventions according to each learner’s barriers for reporting.

Safety culture survey among medical residents in Japan: a nationwide cross-sectional study

“… 26 27 It is believed that because residents are in training and, therefore, are at the bottom of the physician hierarchy, they may be less likely to express their opinions or take part in various medical discussions. 12 25 28 University hospital residents may be significantly more likely to feel punished and emotionally burdened by the act of filing an incident report, according to previous studies that found results that are similar to ours regarding reluctance to submit incident reports. 12 21 22 25 28 Despite the aforementioned cultural context, other studies on registered nurses, physicians, managers and other healthcare professionals have found that managers’ opinions of patient safety culture vary widely, even in the same institutional healthcare setting.…”

“…Furthermore, gender bias (women) has also been noted in university hospitals 26 27. It is believed that because residents are in training and, therefore, are at the bottom of the physician hierarchy, they may be less likely to express their opinions or take part in various medical discussions 12 25 28. University hospital residents may be significantly more likely to feel punished and emotionally burdened by the act of filing an incident report, according to previous studies that found results that are similar to ours regarding reluctance to submit incident reports 12 21 22 25 28.…”

“…However, when adjusted only for the Japanese residents in this study, no significant correlation was found between the nine items of safety culture and reporting experience. A previous Japanese study found that one reason for the lack of submission of incident reports was a requirement for further knowledge of the standards and actual procedures by which incident reports should be made 12. Therefore, if motivating residents to report incidents is currently a priority, perhaps the focus should be changed to educating residents about incident reporting guidelines, necessity, de-escalation processes and so on, rather than tackling the issue from a facility-wide effort perspective, such as enhancing its safety culture 12 33…”

“…Another survey found that 95% of resident physicians committed medical errors, and 20% of those errors were classified as moderate to severe 11. Furthermore, in Japan, more than 70% of resident physicians reported experiencing at least one incident, and facilities’ safety culture influenced error reporting 12. Despite the recognised importance of safety culture in resident physician training, there is limited exploratory research that directly targets resident physicians’ experiences 13–15…”

Distribution of internal medicine rotations among resident physicians in Japan: a nationwide, multicenter, cross-sectional study

“…There is a distinct lack of recent evaluations concerning how these subspecialties are distributed, the duration of each rotation, and the overall coordination of these rotations within the broader framework of the Japanese residency system [ 11 , 12 ]. The term “IM residency program” refers to the full curriculum designed to prepare physicians in internal medicine, whereas “dedicated IM rotations” pertain to the specific weeks within this curriculum that focus solely on internal medicine [ 13 – 15 ].…”