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Barriers to Incident Reporting in Healthcare

By symplr

To understand and improve any system, we must look at its successes and failures. When it’s life and death, healing or inadvertently injuring patients, the stakes could not be higher.

Our healthcare providers and staff undertake complex work under pressure of time constraints, and in environments where priorities shift. These individuals must adhere to hundreds of internal policies and external regulations guiding their actions. Despite all of our best efforts to ensure patient safety, incidents and patient harm occurs.

Research into why incidents occur and whether providers and staff report them isn’t new. But it’s important for healthcare quality and safety leaders to periodically look anew at their data. Is blame or a fear of punishment hindering reporting at your facility? Or is it something simpler—like a lack of time for providers to record the event details? And what about ease of access to a reporting tool?

Site-specific obstacles

There are wide-ranging reasons why providers and staff don’t report incidents. Every facility is different, even across integrated healthcare systems. Regularly assess the potential barriers to reporting in your organization, beginning with the following examples and adding your own.

Worry over legal ramifications

Fear of legal reprisal over a reported incident is common among healthcare staff. Alleviate this fear with education about what’s done with reported data. A standardized incident report form completed properly, stating the facts, should not raise concerns about how it might be used, should legal action occur.

Focus training on:

What to include in a report, and what not to include

How to concentrate on the facts and how to handle second-hand information

How to frame the relevant details, avoiding opinions and blame

Blame and shame culture

Historically, a culture of blame and shame and a fear of reprisal were seen as the biggest factors preventing staff from reporting incidents. Some healthcare organizations have made strides in moving away from such attitudes by successfully adopting “Just Culture,” “Safety II,” or other initiatives. Unfortunately, evidence suggests that most organizations struggle to embrace a blame- and guilt-free environment, making ongoing work to achieve such an environment a necessity.

Lack of time to report

Depending on the unit or department and your geographic location, the nurse-to-patient ratio may range from 1:2 to 1:6 or more. How easy is it for that nurse to stop and report the details of an incident while they are fresh? Giving staff the time and tools they need to complete a report at the time of the incident is essential for promoting safety and compliance. Further, it shows staff that there is nothing more important than their perspective to help learn from mistakes in the current system design.

No easy reporting system

As practitioners increasingly administer care and services in outpatient, ambulatory, or retail clinics; in specialty centers; and via telemedicine, our safety and quality improvement tools must adapt. We must follow the patient and provider to prevent harm. As a result, it’s best practice to use forms easily accessed by computer, tablet, or smartphone to increase participation and compliance, and to capture details that could become lost as time passes.

No trust in follow-up

A healthcare organization that fails to follow-up on reported incidents or to communicate effectively about subsequent actions and resolution has failed in its duty to protect patients, staff, and the organization from harm and liability.

Repeated reports

A sound incident reporting system enables staff and management to be in sync regarding which improvements to prioritize, once risks are identified. Every staff member becomes challenged to do things better and/or differently in their department once it’s determined whether more resources are needed to alleviate the risk. But that can’t happen where there’s a failure to act amid patterns of repeated risk. Reports of incidents that repeat are red flags. Staff who continue to report similar incidents can become demoralized, increasing the risk they won’t report in the future.

Lack of encouragement

Modern methods of shared accountability for healthcare quality improvement carve out a role for everyone in effecting positive change. In addition to a basic willingness for all parties to be open and upfront, it requires a structured top-down approach that involves top management in patient safety efforts. Encouraging and instructing clinicians and staff about how and when to file incident reports is the first step to ensure your entire healthcare team is pulling in the same direction toward safer care.


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