Improving incident reporting among junior doctors

The Perceptions and Experience of Surgical Trainees Related to Patient Safety Improvement and Incident Reporting: Structured Interviews With 612 Surgical Trainees

Background We undertook a prospective qualitative study to ascertain the perceptions and experience of trainee doctors in the first two years of formal core surgical training related to patient safety improvement and incident reporting. We sought to explore the beliefs, knowledge and opinions of core surgical trainees related to patient safety improvement, their understanding of existing patient safety initiatives and their experience and attitudes to incident reporting. Methods We identified 1133 doctors in formal core surgical training posts in the United Kingdom at this time, and we contacted these doctors to invite them to participate in our study. We received responses from 687 (60.6%) core surgical trainees, and 612 trainees (54%) agreed to participate. The study participants underwent an interview using structured questions asked by trained assessors with an opportunity to explore any particular themes identified by the trainee in more detail. Qualitative data related to the knowledge, experience and perceptions of safety improvement and incident reporting were collected. Results Overall, 163 surgical trainees (26.6%) reported that they felt that they could impact patient safety positively. A total of 222 trainees (36.3%) had been involved in or witnessed an adverse patient safety event, while 509 trainees (83.2%) reported that they had witnessed a 'near-miss' event. Only 81 trainees (13.2%) had submitted a patient safety report at some point in their career. In addition, 536 trainees (87.6%) reported that they considered a patient safety or incident report to be 'negative' or 'seriously negative' and that they would be discouraged from making these because of the negative connotations associated with them. Of the 81 core surgical trainees who had submitted a patient safety report, only nine trainees (11.1%) reported that they had received a meaningful reply and update following their report. Several themes were identified during the interviews in response to open questions. These included a perception that patient safety improvement is the responsibility of senior surgeons and managers and that surgical trainees did not feel empowered to influence patient safety improvement. Trainees expressed the view that incident reporting reflected negatively on clinicians and the standard of care provided, and there were reports of culture based on blame and the fear of litigation or complaints. Surgical trainees did not feel that incident reporting was an effective tool for patient safety improvement, and those trainees who had made patient safety reports felt that these did not result in change and that they often received no feedback. Conclusions Core surgical trainees report that they are not well engaged in patient safety improvement and that their perceptions and experience of incident reporting are not positive. This represents a missed opportunity. We suggest that in order to recruit the surgical workforce to the improvement work and learning associated with patient safety, opportunities for focused education, training and culture change are needed from the early years of surgical training. In addition, improvements to the processes and systems that allow trainees to engage with safety improvement are needed in order to make these more user-friendly and accessible.

Practice, perceived barriers and motivating factors to medical-incident reporting: a cross-section survey of health care providers at Mbarara regional referral hospital, southwestern Uganda

BACKGROUND

Medical-incident reporting (MIR) ensures patient safety and delivery of quality of care by minimizing unintentional harm among health care providers. We explored medical-incident reporting practices, perceived barriers and motivating factors among health care providers at Mbarara Regional Referral Hospital (MRRH).

METHODS

We conducted a cross-sectional descriptive study on 158 health provider at Mbarara Regional Referral Hospital (MRRH), Western Uganda. Data was gathered using a structured questionnaire and analyzed with SPSS. The chi-square was used to determine factors associated with MIR at MRRH.

RESULTS

The results showed that there was no formal incident reporting structure. However the medical-incidences identified were: medication errors (89.9%), diagnostic errors (71.5%), surgical errors (52.5%) and preventive error (47.7%). The motivating factors of MIR were: establishment of a good communication system, instituting corrective action on the reported incidents and reinforcing health workers knowledge on MIR (p-value 0.004); presence of effective organizational systems like: written guidelines, practices of open door policy, no blame approach, and team work were significantly associated with MIR (p-value 0.000). On the other hand, perceived barriers to MIR were: lack of knowledge on incidents and their reporting, non-existence of an incident reporting team and fear of being punished (p- value 0.669).

CONCLUSION

Medical Incident Reporting at MRRH was sub-optimal. Therefore setting up an incident management team and conducting routine training MIR among health care workers will increase patient safety.

Raising concerns in the current NHS climate: a qualitative study exploring junior doctors' attitudes to training and teaching

Background

High profile cases continue to demonstrate failures to raise concerns with detrimental effects on patient safety. This research sought to establish what educational support junior doctors needed to effectively raise clinical and professional concerns.

Study design

A qualitative study with 16 participants taking part in three focus groups. The transcripts were thematically analysed.

Results

All the data could be coded into four themes: past experiences of teaching; suggested teaching; reporting mechanisms and educational challenges. Most participants were dissatisfied with the teaching they had received on raising concerns. Current systems were thought to be good for raising patient safety issues but not for concerns about professional behaviour of healthcare staff.

Conclusions

There is a need for improved education to tackle the way this is taught in postgraduate curricula. Frequent rotations and a lack of meaningful relationships left junior doctors feeling less invested in improving organisational culture. Junior doctors are apprehensive about raising concerns because of personal risk to their career trajectory.

Incident reporting behaviours following the Francis report: A cross-sectional survey

RATIONALE, AIMS, AND OBJECTIVES

Previous studies have shown a lack of engagement in the reporting process. There is limited evidence about whether attitudes and behaviours of doctors in the UK towards incident reporting have changed following the events at Mid Staffordshire National Health Service Foundation Trust and the recommendations that followed. We conducted a relatively large survey of doctors, aiming to assess whether doctors recognised incidents and reported them accordingly, along with their behaviours towards reporting and their suggestions of how incident reporting may be improved.

METHODS

A cross-sectional survey of doctors was undertaken in 11 hospitals in the north of England. The participants (n = 581) were invited to take part in an electronic questionnaire. Demographics were obtained, and engagement with the incident reporting process was assessed, including an estimate of the number of incidents which were witnessed but not actually reported. Factors which influenced reporting behaviours were recorded. Free-text comments were encouraged. A mixed method analysis of the responses was performed.

RESULTS

Doctors do not appear to be engaging with the incident reporting process-in particular, junior doctors. The main reason given for not completing forms was not having enough time (38.2% of respondents), primarily due to the length and complexity of forms. Many doctors, 43.7%, witnessed more than 5 incidents, but only 13.3% of doctors submitted more than 5 reports. Free text comments revealed 4 themes which impact upon reporting behaviours: organisational issues, form structure, a culture of blame, and a lack of feedback. Several suggestions for improvement were made.

CONCLUSIONS

Little has changed in the attitudes and behaviours of doctors. Improving incident reporting form structure to make it more user-friendly and improving feedback may engage doctors and lead to an improved safety culture. The way the medical profession reports serious and other incidents still needs to be improved.