Hospital-Based Views and Practices Related to Incident Reporting and Patient Safety: A Qualitative Comparative Study of Two Divisions

Tanya Hewitt, Université D'Ottawa / University Of Ottawa, Université D'Ottawa / University Of Ottawa
2015
Patient safety has been on the research agenda since 2000, when unnecessary harm to patients in providers' care came to light. In 2005, the improvements in patient safety fell short of expectations, and the patient safety research community recognized that the issues are more difficult to resolve than first thought. One of the tools to address this vexing problem has been voluntary incident reporting systems, although the literature has given incident reporting systems mixed reviews. This
more » ... reviews. This qualitative comparative case study comprises 85 semi-structured interviews in two separate divisions of a tertiary care hospital, General Internal Medicine (GIM) and Obstetrics and Neonatology (OBS/NEO). The main line of questioning concerned incident reporting; general views of patient safety were also sought. This is a thesis by publication. The thesis consists of a general introduction to patient safety, a literature review, a description of the methods and cases, followed by the manuscripts. The thesis concludes with a summarization of the findings, and implications of the study. Manuscript one focuses on the reporter end of incident reporting systems. It asks what frames underlie GIM nurse and physician self reporting and peer reporting practices. The findings showed that frames that inhibit reporting are shared by physicians and nurses, such as the fear of blame frame regarding self reporting, and the tattletale frame regarding peer reporting. These frames are underpinned by a focus on the individual, despite the organisational message of reporting for learning. A learning frame is an enabler to incident reporting. Viewing the objective of voluntary incident reporting as learning allows practitioners to depersonalize incident reporting. The focus becomes preventing recurrence and not the individual reporting or reported on. Manuscript two again focuses on the reporter end, and on one type of reportable incident – a problem that healthcare practitioners can fix themselves. The study asks: when faced with such a problem, do [...]
doi:10.20381/ruor-4062 fatcat:v4k3cpiaifgc5px6gijqxm7gxe