Barriers to reporting near misses and adverse events among professionals performing laparoscopic surgeries: a mixed methodology approach.

Abstract

The literature has investigated barriers to reporting adverse events in surgery, but with less emphasis on near misses. No attempt was made to categorise near misses by type and reportability. This paper attempts to fill these two gaps in the literature. A mixed methodology approach was adopted. A sample of 16 laparoscopic surgeries were observed followed by a questionnaire distributed among professionals dealing with laparoscopies. Non-parametric tests and mediation-moderation analysis were used to compare responses and identify causal factors. A total of 469 near misses were observed, and classified into two categories: reportable events and common events. Among 23 observed reportable events, only 9 events were reported. Out of 300 distributed questionnaires, we received 178 valid responses (response rate 59%). The professionals strongly disagreed that reporting near misses (Mean 4.09, STD 0.95) and adverse events (4.17, 1.02) makes little contribution to the quality of surgery. However, the results show that professionals were more willing to disclose adverse events than near misses, Heavy workload, privacy, lack of support, and fear from disciplinary actions negatively affected professionals' willingness to report near misses. Error reporting should aim to promote safety, knowledge sharing and education. It is important to differentiate near misses that should be reported from voluntary reported events. Hospital's management might award professionals who frequently report errors and provide solutions, Quality rather than quantity of reports should be emphasised with flexibility in the way near misses are reported. The outcome of this study has benefits of understanding the attitudes of surgical professionals towards error reporting. It provides healthcare management with tool for enhancing safety and providing suitable training for their professionals.