Cultural Barriers and Enablers for Event Reporting

Abstract

The purpose of this work was to identify opportunities for increasing event reporting based on a national survey on patient safety culture in a radiation medicine department. The National Hospital Patient Safety Culture Survey developed by the Agency for Healthcare Research and Quality (AHRQ) was disseminated to all staff members of our multi-center radiation medicine department via a web-based tool (Survey Monkey). The overall survey score was the fraction of responses deemed favorable for patient safety as per AHRQ guidelines. Apart from demographic questions, all 42 Likert-scale questions of the survey were mandatory. Completed surveys were amalgamated, and scores computed overall, per question, and per department work staff division. An additional survey question probed respondents on their annual frequency of event reporting with 6 choices ranging from none to over 21. The fraction of responses other than “None” yielded the event reporting rate. Linear regression analysis was performed for the division event reporting rate with each of the 42 questions scored per division. In addition, members of the incident learning system (ILS) analysis team completed an in-house survey to compare the impact of our internal ILS with the national Radiation Oncology Incident-Learning System (RO-ILS) in our department. The overall patient safety culture score was 67.8% (AHRQ average 65%). The department event reporting rate was 49% (> 50th and <75th percentile of all AHRQ respondents). The event reporting rate trends correlated well with survey scores on 4 of the 42 questions (Pearson correlation coefficient > 0.70, p-value <0.05). These were 1) It is just by chance that more serious mistakes don't happen around here (66.4% disagreed); 2) Staff feel like their mistakes are held against them (54% disagreed); 3) My supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures (71.9% agreed); and 4) Mistakes have led to positive changes here (66.4% agreed). In the 2nd survey 82% of the respondents felt that having an ILS improves patient safety culture. 100% felt that even low-severity reports should be filed as fixing such errors may help improve processes in the long run. Neither ILS had a distinct relative advantage towards making our culture safer, but there were slight differences between perceptions of use patterns. Enablers for event reporting include staff perceiving a systematic department effort towards safety, a non-punitive environment for reporting, management appreciation for staff complying with safety guidelines, and impactful departmental responses to reported mistakes. Opposing perceptions are barriers. Having an ILS alongside a culture that supports even low-severity event reporting is perceived to improve reporting and patient safety. The AHRQ survey may be potentially useful for other departments seeking similar insights.