Article Tools
Focus on Quality
Original Contributions
Article Tools
Physician Attitudes and Practices Related to Voluntary Error and Near-Miss Reporting
Abstract
Physicians are less likely to report events than other colleagues. There are barriers to physician reporting that need to be addressed to encourage reporting and create a fair culture around reporting.
Incident learning systems are important tools to improve patient safety in radiation oncology, but physician participation in these systems is poor. To understand reporting practices and attitudes, a survey was sent to staff members of four large academic radiation oncology centers, all of which have in-house reporting systems.
Institutional review board approval was obtained to send a survey to employees including physicians, dosimetrists, nurses, physicists, and radiation therapists. The survey evaluated barriers to reporting, perceptions of errors, and reporting practices. The responses of physicians were compared with those of other professional groups.
There were 274 respondents to the survey, with a response rate of 81.3%. Physicians and other staff agreed that errors and near-misses were happening in their clinics (93.8% v 88.7%, respectively) and that they have a responsibility to report (97% overall). Physicians were significantly less likely to report minor near-misses (P = .001) and minor errors (P = .024) than other groups. Physicians were significantly more concerned about getting colleagues in trouble (P = .015), liability (P = .009), effect on departmental reputation (P = .006), and embarrassment (P < .001) than their colleagues. Regression analysis identified embarrassment among physicians as a critical barrier. If not embarrassed, participants were 2.5 and 4.5 times more likely to report minor errors and major near-miss events, respectively.
All members of the radiation oncology team observe errors and near-misses. Physicians, however, are significantly less likely to report events than other colleagues. There are important, specific barriers to physician reporting that need to be addressed to encourage reporting and create a fair culture around reporting.
A number of international and national health organizations (WHO, International Atomic Energy Agency, and American Society for Radiation Oncology) advocate the use of a reporting system as part of an overall safety practice program in the delivery of radiotherapy.1–3 Learning from errors and near-miss events is an essential step in developing mechanisms and processes to prevent future occurrences of similar events. Recommendations also now exist on how to build such a reporting system (or incident learning system) in a radiation oncology setting.4
Other industries, such as the nuclear power industry, have highly successful reporting systems; a rigorous risk analysis process; and, not coincidentally, a low incident rate.5,6 However, in the nuclear power setting, this sophisticated reporting system relies on a safe and fair reporting culture. There is a clear understanding within their community that reporting contributes to the personal safety of the individuals working in the nuclear power plant as well as the safety of the general public. The same culture is more difficult to establish in health care, where physicians and hospital administrators must balance accountability with fear of damage to their reputation and malpractice liability.7
A previous investigation of actual practices of reporting medical errors among physicians and residents of internal medicine in teaching hospitals found that despite 84.3% of physicians believing that reporting medical errors improves quality, only 16.9% admitted reporting a minor error, and 3.8% acknowledged reporting a major error.8 These findings point to an important disparity between belief systems and actions among physicians with respect to reporting medical errors and speak to the number of obstacles that health care leaders face in implementing successful reporting systems.
In this article, we present the results of a multi-institutional survey that investigated the barriers and attitudes associated with reporting errors and near-miss events to an incident reporting system in a radiation oncology setting. An evaluation of incident reporting systems of two large academic radiation oncology departments found that physicians submitted zero of 4,407 reports recorded between December 2010 and July 2011.9 On the basis of these pilot data that suggested physicians were particularly hesitant to participate in such systems, we focused on characterizing the barriers and attitudes that physicians have toward error reporting as compared with other staff members in four radiation oncology departments.
Institutional review board approval was obtained to send an electronic survey to all clinical staff members (attending physicians, resident physicians, dosimetrists, nurses, physicists, and radiation therapists) of four academic radiation oncology departments. These departments were selected because all had previously implemented sophisticated in-house reporting systems. The intent of the survey, noted on the welcome page, was to understand attitudes and behaviors related to the voluntary reporting of errors and near-miss events. We created a 24-item questionnaire to evaluate self-described reporting patterns, barriers to reporting, perceived usefulness of reporting, perceptions about the frequency of errors and near-miss events, and department reporting culture. Questions to interrogate these domains were developed by referencing the Safety Attitudes Questionnaire.10 Fourteen of the 24 items in the survey used a 5-point Likert scale (disagree strongly, disagree, neutral, agree, and agree strongly; Appendix, online only).11
A pilot survey was tested with eight participants from the four institutions to ascertain the clarity of wording and content in the survey. The final survey was converted to electronic form within SurveyMonkey, and a link to the survey was sent out to all departmental members. Respondents completed the survey between March and April of 2011 and were sent three electronic reminders to increase response rates. The respondents remained anonymous, and the only demographic questions included professional role and years of experience in that role.
The survey contained four questions about whether or not respondents had ever observed and/or reported a minor or major near-miss or a minor or major error. A near-miss event was defined as any error that almost occurred but was averted because of an intervening factor. An error was defined as any preventable event that resulted in a radiation misadministration, patient injury or discomfort, or treatment delay, and ranged in severity from those that resulted in no harm to those that resulted in serious harm or death.
The survey assessed the concerns and barriers identified by respondents with respect to reporting errors and near-miss events. All respondents were asked to designate whether or not and the degree to which the following barriers were relevant in their reporting practices on a Likert scale: departmental or professional sanctions, getting colleagues into trouble, admitting liability, embarrassment, retribution from colleagues, and concern about damaging the department's reputation. Respondents were also asked to identify the most important sources of errors and near-miss events from a list that included communication failures, failure to follow standard operating procedures, technical failures (hardware and software errors), and insufficient training. Finally, the survey included a question to ascertain whether respondents would use a national reporting system, if one were available, to report errors or near-miss events. All questions that used a Likert scale were ultimately dichotomized, grouping neutral and negative responses together to place the primary analytic focus on positive responses. Data were transferred from SurveyMonkey to SAS for further analysis.
Once the responses were dichotomized, analyses on proportion difference between groups was performed using χ2 tests with respect to the responses of physicians compared with the combined responses from other professional groups (ie, dosimetrists, nurses, physicists, and radiation therapists). We collected information on reporting barriers and attitudes as well as on self-described reporting practices. This initial analysis was to explore whether prevalent concerns about certain barriers accompany less robust reporting, with the ultimate goal being to understand the motivators that shape reporting patterns of physicians versus other staff members. For these analyses, self-described reporting patterns were used as the dependent variables, and the data collected regarding barriers and attitudes were evaluated as independent variables. The independent variables were specified and evaluated using backward step-wise logistic regression analysis, with a cutoff P value of .05 used to evaluate statistical significance. In this way, data regarding identified barriers and attitudes were evaluated according to whether they was linked to incident reporting patterns.
Throughout this article, the physician group refers to both the attending and resident physicians. All the other groups, the nonphysicians, refer to the combination of dosimetrists, nurses, physicists, and radiation therapists.
There were 274 respondents to the survey, including 41 attending physicians, 26 resident physicians, 31 dosimetrists, 53 nurses, 47 physicists, and 76 radiation therapists. The overall response rate was 81.3%, with subgroup response rates of 89.1% (attending physicians), 68.4% (residents), 96.9% (dosimetrists), 69.7% (nurses), 95.9% (physicists), and 79.1% (radiation therapists).
The majority of members of the radiation oncology team from the four institutions reported that errors and near-miss events do happen in their department. Ninety-four percent of physicians and 88.7% of nonphysicians responded that they disagreed with the notion that there are no error-related events to report in their department (P = .245), and 97% overall felt it was their responsibility to report. When respondents were asked specifically about their knowledge of how to report an error, 72.3% of physicians agreed that they knew how to report events, and 84.5% of nonphysicians reported the same (P = .028). Respondents also appeared to know what kinds of errors/near-misses to report: 73.9% of physicians reported that they knew what kinds of errors to report, and 85.6% of nonphysicians reported the same (P = .030; Table 1).
|
| Survey Question | Finding |
|---|---|
| I know errors/near-misses happen, but my team is so careful we do not have events to report | |
| Disagree, % | P = .245 |
| Physicians | 93.8 |
| All other groups | 88.7 |
| It is my responsibility to report errors/near-misses within my department | |
| Agree, % | P = .259 |
| Physicians | 95.4 |
| All other groups | 98.0 |
| I know how to report errors/near-misses within my department | |
| Agree, % | P = .028 |
| Physicians | 72.3 |
| All other groups | 84.5 |
| I know what kinds of errors/near-misses should be reported to my department | |
| Agree, % | P = .030 |
| Physicians | 73.9 |
| All other groups | 85.6 |
NOTE. Survey questions are presented verbatim.
Looking first at errors, among all respondents, 26% acknowledged sometimes or always failing to report a minor error, and 4.1% acknowledged failing to report a major error. Comparing physicians with nonphysicians, there was statistically significantly less reporting of minor events among the former. Specifically, 37.3% of physicians admitted to failing to report minor errors, and 22.5% of nonphysicians admitted the same (P = .024). It appears that all groups had members who sometimes or always failed to report major errors. According to the survey, 6.7% of physicians acknowledged failing to report a major error, and 3.3% of nonphysicians acknowledged the same (P = .248; Table 2)
|
| Role | Minor Near-Misses | Major Near-Misses | Minor Errors | Major Errors |
|---|---|---|---|---|
| Physicians | 56.9 | 13.6 | 37.3 | 6.7 |
| All other groups | 32.6 | 16.4 | 22.5 | 3.3 |
| Overall | 38.3 | 15.7 | 26.0 | 4.1 |
| P = .001 | P = .601 | P = .024 | P = .248 |
NOTE. The following definitions were provided at the top of each page of the safety survey: Near-misses: A near-miss is any error that almost happened but was averted because of luck, safety measures, or some other intervening factor. Errors: An error is any preventable event that results in radiation misadministration, patient injury or discomfort, or treatment delay, ranging in severity from those that result in no harm to those that result in serious harm or death. Minor versus major: The questions below draw a distinction between minor errors and near-misses and major errors and near-misses. Minor errors and near-misses are problems that could result in delay, discomfort, or treatment deviation but are unlikely to harm patients. Major errors and near-misses are therefore those problems that are likely to lead to patient harm.
Looking next at near-miss events, it appears that within both groups, minor near-miss events were under-reported, particularly so with physicians. Of the physician respondents, 56.9% had failed to report a minor near-miss event, and 32.6% of respondents in the other groups reported the same (P = .001). By contrast, only 13.6% of physicians and 16.4% of nonphysicians indicated that they had failed to report a major near-miss event (P = .601).
Of the five items listed as possible concerns when it comes to reporting, embarrassment in front of colleagues appeared to be an important barrier. This was especially true among physicians; 52.3% of physicians were concerned about embarrassment compared with 27.6% of respondents from the other groups (P < .001). Three other concerns were statistically significantly more important to physicians compared with nonphysicians: getting colleagues into trouble (47.7% of physicians and 31.1% of nonphysicians, P = .015), admitting liability (41.5% of physicians and 24.6% of nonphysicians, P = .009), and effect on departmental reputation (46.2% of physicians and 27.6% of nonphysicians, P = .006). The highest ranking concern among the other groups was departmental or professional sanctions, but there was not a statistical difference between physicians and the other professional groups in terms of this concern (Table 3).
|
| Item | Percentage of Respondents Indicating Yes | P | |
|---|---|---|---|
| Physicians | All Other Groups | ||
| In general, when thinking about reporting errors/near-misses, I am concerned about: | |||
| Departmental or professional sanctions | 44.6 | 35.7 | .197 |
| Getting my colleagues in trouble | 47.7 | 31.1 | .015 |
| Admitting liability | 41.5 | 24.6 | .009 |
| Embarrassment in front of colleagues | 52.3 | 27.6 | < .001 |
| The effect it may have on our department's reputation | 46.2 | 27.6 | .006 |
| None (I have no concerns) | 61.5 | 51.3 | .149 |
| What are important sources of errors/near-misses in your department? | |||
| Communication failures | 80.0 | 85.9 | .252 |
| Failure to follow standard operating procedures | 47.7 | 45.7 | .783 |
| Technical failures (hardware and software errors) | 49.2 | 36.2 | .062 |
| Insufficient training | 26.2 | 27.1 | .877 |
| Too high a workload | 53.9 | 43.7 | .155 |
When asked about important sources of errors in a radiation oncology department, 80% of physicians and 85.9% of nonphysicians felt that communication failures were a primary source of error. Just under half of respondents (47.7% of physicians and 45.7% of nonphysicians) indicated that failing to follow standard operating procedures was also a source of failure. Among physicians, 49.2% felt that technical failures were a source of failure, whereas only 36.2% of respondents from the other groups reported the same (P = .062). Approximately one third of both groups (26.2% of physicians and 27.1% of nonphysicians; P = .877) responded that insufficient training was a source of errors, and approximately half of respondents (53.9% of physicians and 43.7% of nonphysicians; P = .155) responded that overburdened workloads were a source of errors.
Multivariable analysis was used to evaluate the relative importance of various barriers to the four possible incidents that respondents provided data on (minor near-miss, minor error, major near-miss, and major error). The most important variable linked to reporting behavior was professional designation, as respondents were almost three times (odds ratio [OR] = 2.725) more likely to report if they were nonphysicians as compared with physicians. Physicians were less likely to report minor near-miss events (OR = 0.367), minor errors (OR = 0.591), and major errors (OR = 0.472) than their coworkers. If embarrassment was not a concern, all respondents were 2.5 times more likely to report minor errors and 4.5 times more likely to report major near-miss events.
The results of this study indicate that there is room for improvement in reporting patterns for all members of the radiation oncology team, but particularly so for physicians. Our data are consistent with the reporting patterns of physicians from other disciplines.7,8,12 According to our results, physicians have the desire to report and know how to do so. However, previous measures of actual reporting practices by radiation oncology physicians indicate that they are not reporting.9 It is possible that physicians do not observe as many near-misses and errors as other members of the team. Radiation oncology physicians do not see the patient daily and therefore may not encounter as many potential sources of error as downstream caregivers, such as radiation therapists. It is also possible that if multiple team members are aware of an incident, the incident is reported into the incident reporting system by someone other than the physician. However, the errors that physicians encounter on their own may carry a higher risk of severity than those encountered by other members of the team, such as defining the target incorrectly, misidentifying tumor laterality, or misinterpreting localization images. These high-risk errors are also difficult to detect, as they require a certain degree of specialization and would not be obvious to other staff members. It is critical that if physicians are making, observing, or catching these types of errors, they are also reporting them.
Most notable from the results of the survey is that embarrassment is a critical barrier for all staff members. Multivariable analysis indicated that respondents were much more likely to report minor errors and major near-misses if embarrassment were not a factor. Physicians consider embarrassment a bigger issue than nonphysicians. If concerns of embarrassment are the physicians' biggest barrier to reporting the critical errors that they see, then this speaks directly to the culture of reporting errors that exists within the medical community. A possible method of reducing professional embarrassment may be to have frequent case reporting at departmental morbidity and mortality conferences. If errors and near-miss events are presented on a regular basis in a clear and nonthreatening environment where the goal is to learn from each other's mistakes, professionals may feel less intimidated by admitting their own mistakes.
The consequences of reporting medical errors for health care workers are broad and complex. Morality and ethics rules insist that medical errors be disclosed in a timely and honest fashion, especially when the disclosure also means notifying the patient and family.13 However, disclosing a medical error ultimately means that the practitioner must admit to violating the principle of nonmaleficence.13 The emotional distress of this disclosure can leave physicians feeling upset, guilty, self-critical, depressed, and scared.14 In addition, in our current health care climate, the practitioner must also face potential job sanctions and malpractice litigation.14 It has been shown that a substantial number of radiation oncology physicians believe that error disclosure increases the likelihood of lawsuits.15 When faced with these consequences, the impulse to “deny and defend” as opposed to “disclose and apologize” must be acknowledged, and steps must be taken to overcome it.13,16 A successful, voluntary reporting system will only find success in a health care system that encourages disclosure and honesty, and where errors are seen as a result of a faulty system rather than individual negligence.
A national reporting system for radiation oncology is needed.9 The system should provide guidelines on how and what to report in order to promote engagement.17 Kaldjian et al8 have shown that physicians would be more likely to report errors if they had tools to identify those critical errors that have the biggest impact on patient safety and if they received feedback on how error reporting affected patient care. Indeed, our results indicate that more than half of radiation oncology staff members would report if they received feedback on the errors they were reporting. Some departments are now experimenting with regular morbidity and mortality rounds based on incident reports (usually near-miss incidents); this provides a forum for understanding how individual events were handled and for formulating process-improvement strategies. This type of forum could be broadened to a national level with a national reporting system so that centers across the country can learn from common mistakes and share ideas for effective interventions.
Whether on a national or departmental level, minor and major near-miss events represent important opportunities to learn from mistakes that have not yet affected patients.8 By definition, a near-miss incident was detected by some intervening strategy for catching errors or by chance and did not harm the patient. This type of incident not only points out potential future errors, but also highlights the effective strategy or tool by which the near-miss event was detected. This becomes important in thinking about prevention methods for other types of errors, as we have seen that not all quality control checks are effective.18 A frequent and thorough analysis of one's own internal incidents may also reveal systematic “holes” in the system, which would not have been identified otherwise. When near-miss reports, even those that are viewed as relatively minor events, are reviewed systematically, other more serious accidents may be prevented, as demonstrated in a recent report.19
One strength of this study is the response rate (81.3%). This was achieved by sending three electronic reminders to participants and by having a physician champion in each department who actively encouraged participation in the survey. However, because the target was large academic centers, the population of respondents may be somewhat uniform, which makes it difficult to make generalizations for all types of professionals across different types of radiation oncology centers. In addition, the centers polled had existing incident reporting systems and a history of work done in the realm of patient safety and error reporting. The respondents have experience in the consequences of reporting, whether negative or positive, whereas those from centers new to the culture of reporting may have a different set of challenges. Another limitation of the study is its dependence on self-reported behaviors rather than actual behaviors. Finally, Likert scales were used for many of the possible responses, and they are subject to acquiescence bias and central tendency bias.
The reporting of errors and near-misses by members of four large academic radiation oncology departments has room for improvement, and this investigation identified barriers to reporting that may be targeted. This study confirms that all team members feel that reporting errors and near-miss events is their responsibility. However, it is clear that cultural concerns exist, including reluctance to face embarrassment in front of colleagues, which may be a particular hindrance to physicians. These attitudes will remain as barriers that prevent physicians and other staff members from reporting errors unless institutional and professional leaders directly address them and seek to create a safety culture that starts at the level of the hospital leadership and extends down to the level of the medical student. The success of implementing a national reporting system in the field of radiation oncology will depend on acknowledging and removing barriers to reporting.
Although all authors completed the disclosure declaration, the following author(s) and/or an author's immediate family member(s) indicated a financial or other interest that is relevant to the subject matter under consideration in this article. Certain relationships marked with a “U” are those for which no compensation was received; those relationships marked with a “C” were compensated. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors.
Employment or Leadership Position: None Consultant or Advisory Role: Sasa Mutic, ViewRay (C) Stock Ownership: Sasa Mutic, Radialogica, TreatSafely Honoraria: Sasa Mutic, Varian Medical Systems, ViewRay Research Funding: None Expert Testimony: None Patents, Royalties, and Licenses: None Other Remuneration: Sasa Mutic, Varian Medical Systems, ViewRay
Conception and design: Kendra M. Harris, Eric Ford, Stephanie Terezakis
Collection and assembly of data: Kendra M. Harris, Louis Potters, Rajiv Sharma, Sasa Mutic, Hiram A. Gay, Jean L. Wright, Stephanie Terezakis
Data analysis and interpretation: Koren Smith, Kendra M. Harris, Louis Potters, Hiram Alberto Gay, Michael Samuels, Xiaobu Ye, Eric Ford, Stephanie Terezakis
Manuscript writing: All authors
Final approval of manuscript: All authors
| 1. | L Donaldson : Radiotherapy Risk Profile, Technical Manual 2008 Geneva, Switzerland World Health Organization Press Google Scholar |
| 2. | P Andreo, M Cohen, J Gultresa , etal: Lessons Learned from Accidental Exposures in Radiotherapy 2000 Vienna, Austria IAEA Safety Report Series 17 Google Scholar |
| 3. | AL Zietman, JR Palta, ML Steinberg , etal: Safety Is No Accident: A Framework for Quality Radiation Oncology Care 2012 Fairfax, VA American Society for Radiation Oncology Google Scholar |
| 4. | EC Ford, LE Fong de Los Santos, T Pawlicki , etal: Consensus recommendations for incident learning database structures in radiation oncology Med Phys 39: 7272– 7290,2012 Crossref, Medline, Google Scholar |
| 5. | Nuclear Power Plant Operating Experience 2012 Paris, France IAEA/NEA International Reporting System for Operating Experience 2009-2011 Google Scholar |
| 6. | AA Abagian, Y Ma, CJ Allan , etal: Basic Safety Principles for Nuclear Power Plants 75-INSAG-3 Rev. 1: INSAG-12 1999 Vienna, Austria International Nuclear Safety Advisory Group Google Scholar |
| 7. | LL Leape : Reporting of adverse events N Engl J Med 347: 1633– 1638,2012 Crossref, Google Scholar |
| 8. | LC Kaldjian, EW Jones, BJ Wu , etal: Reporting medical errors to improve patient safety Arch Intern Med 168: 40– 46,2008 Crossref, Medline, Google Scholar |
| 9. | SA Terezakis, KM Harris, E Ford , etal: An evaluation of departmental radiation oncology incident reports: Anticipating a national reporting system Int J Radiat Oncol Biol Phys 85: 919– 923,2013 Crossref, Medline, Google Scholar |
| 10. | JB Sexton, RL Helmreich, TB Neilands : The Safety Attitudes Questionnaire: Psychometric properties, benchmarking data, and emerging research BMC Health Serv Res 6: 44,2006 Crossref, Medline, Google Scholar |
| 11. | JB Sexton, EJ Thomas, P Pronovost : The context of care and the patient care team: The Safety Attitudes Questionnaire Building a Better Delivery System: A New Engineering/Health Care Partnership 119– 123, Washington DC National Academies Press Google Scholar |
| 12. | RJ Blendon, CM DesRoches, M Brodie , etal: Views of practicing physicians and the public on medical errors N Engl J Med 347: 1933– 1940,2002 Crossref, Medline, Google Scholar |
| 13. | C Rathert, W Phillips : Medical error disclosure training: Evidence for values-based ethical environments J Bus Ethics 97: 491– 503,2010 Crossref, Google Scholar |
| 14. | AD Waterman, J Garbutt, E Hazel , etal: The emotional impact of medical errors on practicing physicians in the United States and Canada Jt Comm J Qual Patient Saf 33: 467– 476,2007 Crossref, Medline, Google Scholar |
| 15. | SB Evans, JB Yu, A Chagpar : How radiation oncologists would disclose errors: Results of a survey of radiation oncologists and trainees Int J Radiat Oncol Biol Phys 84: e131– e137,2012 Crossref, Medline, Google Scholar |
| 16. | RC Boothman, SJ Imhoff, DA Campbell Jr: Nurturing a culture of patient safety and achieving lower malpractice risk through disclosure: Lessons learned and future directions Front Health Serv Manage 28: 13– 28,2012 Crossref, Medline, Google Scholar |
| 17. | BD Winters, SM Berenholtz, P Pronovost : Improving patient safety reporting systems Crit Care Med 35: 1206– 1207,2007 Crossref, Medline, Google Scholar |
| 18. | EC Ford, S Terezakis, A Souranis , etal: Quality control quantification (QCQ): A tool to measure the value of quality control checks in radiation oncology Int J Radiat Oncol Biol Phys 84: e263– e269,2012 Crossref, Medline, Google Scholar |
| 19. | EC Ford, K Smith, K Harris , etal: Prevention of a wrong–location misadministration through the use of an intradepartmental incident learning system Med Phys 39: 6968– 6971,2012 Crossref, Medline, Google Scholar |
Does your department have a system (paper or electronic) for reporting errors and near-misses?
Yes
No
I do not know
I would prefer not to answer
What is your role within your radiation oncology department?
Radiation therapist
Physicist
Dosimetrist
Nurse
Attending/faculty
Resident
Physician assistant/nurse practitioner
Administrative staff
Information technology/biomedical engineering
Other
How long have you worked in this role (in your current department)?
1 to 5 years
6 to 10 years
10 to 15 years
16 to 20 years
21 to 25 years
26 to 30 years
Greater than 30 years
A near-miss is any error that almost happened but was averted because of luck, safety measures, or some intervening factor.
An error is any preventable event that results in radiation misadministration, patient injury or discomfort, or treatment delay and ranges in severity from those that result in no harm to those that result in serious harm or death.
The questions below draw a distinction between minor errors and near-misses and major errors and near-misses. Minor errors and near-misses are problems that could result in delay, discomfort or treatment deviation but are unlikely to harm patients. Major errors and near-misses are therefore those problems which are likely to lead to patient harm.
Have you ever caught a MINOR mistake before it happened (a “near-miss”) that would have resulted in care being prolonged or delivered incorrectly and, after correcting the problem:
I have both REPORTED and NOT REPORTED instances of which I was aware
Always REPORTED it to my supervisor or department reporting system
Never REPORTED it to my supervisor or department reporting system
I have never caught a minor “near-miss” in our department
I would prefer not to answer this question
Other (please specify)
Have you ever caught a mistake before it happened (a “near-miss”) that would have resulted in MAJOR harm or disability and, after correcting the problem:
I have both REPORTED and NOT REPORTED instances of which I was aware
Always REPORTED it to my supervisor or department reporting system
Never REPORTED it to my supervisor or department reporting system
I have never caught a major “near-miss” in our department
I would prefer not to answer this question
Other (please specify)
Have you ever made a MINOR mistake (error) or observed someone else make a minor mistake that resulted in treatment being delivered incorrectly and:
I have both REPORTED and NOT REPORTED instances of which I was aware
Always REPORTED it to my supervisor or department reporting system
Never REPORTED it to my supervisor or department reporting system
I have never made or observed a minor mistake in our department
I would prefer not to answer this question
Other (please specify)
Have you ever made a mistake (error) or observed someone else make a mistake that caused MAJOR harm or disability and:
I have both REPORTED and NOT REPORTED instances of which I was aware
Always REPORTED it to my supervisor or department reporting system
Never REPORTED it to my supervisor or department reporting system
I have made or observed a major error in our department
I would prefer not to answer this question
Other (please specify)
In general, when thinking about reporting errors/near-misses, I am concerned about:
Departmental or professional sanctions (Yes/No)
Getting my colleagues in trouble (Yes/No)
Admitting liability (Yes/No)
Embarrassment in front of colleagues (Yes/No)
Provoking retribution from colleagues (Yes/No)
The effect it may have on our department's reputation (Yes/No)
Other
If there were a national system for anonymous error/near-miss reporting, I would report:
Actual errors
Near-misses
I would be unlikely to participate in a national reporting system
What are important sources of errors/near-misses in your department?
Communication failures
Failure to follow standard operating procedures
Technical failures (hardware and software errors)
Insufficient training
Too high a workload
We do not have errors or near-misses occur in our department
Other (please specify)
The following questions used the following 5-point Likert scale for possible responses:
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
I would prefer not to answer
It is my responsibility to report errors/near-misses within my department.
I know how to report errors/near-misses within my department.
I know what kinds of errors/near-misses should be reported to my department.
I would report errors/near-misses if I were not so busy.
I would be more likely to report errors/near-misses to my department if it were easier to do.
I would be more likely to report errors/near-misses to my department if it were anonymous.
I would be more likely to report errors/near-misses to my department if I received feedback afterwards.
I have confidence that my error/near-miss reports get used to improve our system.
I know errors/near-misses happen, but my team is so careful we do not have events to report.
I believe that my colleagues value error and near-miss reporting.
I believe that my colleagues would report an error or a near-miss that I caused.
I believe that my colleagues would report an error or a near-miss that they caused.
