The Culture of Incident Reporting and Feedback: A Cross-Sectional Study in a Hospital Setting
Affiliation(s)
1 Department of Research, Innlandet Hospital Trust, Brumunddal, Norway. 2 Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. 3 Department of Quality and Patient Safety, Innlandet Hospital Trust, Brumunddal, Norway. 4 Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway.
1 Department of Research, Innlandet Hospital Trust, Brumunddal, Norway. 2 Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. 3 Department of Quality and Patient Safety, Innlandet Hospital Trust, Brumunddal, Norway. 4 Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway.
ABSTRACT
A safety culture where incidents have been reported and feedback given is essential to detect and understand system failures. The aims of this study were to examine the culture of incident reporting and feedback (the incident culture) in a hospital setting, and the associations between the incident culture and other dimensions of the safety culture. A cross-sectional study was carried out with the instrument Hospital Survey on Patient Safety Culture (HSOPSC) within 16 units in six somatic hospitals at a Norwegian Hospital Trust. Units with identical specialities across the hospitals constitute a clinic. HSOPSC measures the health care personnel’s perception of the safety culture, seven safety dimensions at the unit level, three at the hospital level and four outcome measures. The outcome measures “Frequency of event reporting” and the dimension “Feedback and communication about error” were combined into the variable “incident culture”, score 1 - 5. A positive score was defined as ≥ 4.0. This study included 631 health care personnel. The mean score for the incident culture was 3.10 (SD 0.65) with significant differences between the clinics, and the hospitals. The strongest predictors for the incident culture were the dimensions “Communication openness” (linear regression slope B 0.470; 95% CI 0.398 to 0.543; p < 0.001), “Manager expectations and actions promoting safety” (B 0.378; 95% CI 0.304 to 0.453; p < 0.001), “Organisational learning and continuous improvement” (B 0.374; 95% CI 0.293 to 0.455; p < 0.001) and “Teamwork across hospital units” (B 0.360; 95% CI 0.261 to 0.459; p < 0.001). In this study, the incident culture needed improvements. To improve the incident culture, the attention may be directed towards developing and maintaining a culture of open communication, management that promotes safety, and a learning organisation and teamwork between the units.
A safety culture where incidents have been reported and feedback given is essential to detect and understand system failures. The aims of this study were to examine the culture of incident reporting and feedback (the incident culture) in a hospital setting, and the associations between the incident culture and other dimensions of the safety culture. A cross-sectional study was carried out with the instrument Hospital Survey on Patient Safety Culture (HSOPSC) within 16 units in six somatic hospitals at a Norwegian Hospital Trust. Units with identical specialities across the hospitals constitute a clinic. HSOPSC measures the health care personnel’s perception of the safety culture, seven safety dimensions at the unit level, three at the hospital level and four outcome measures. The outcome measures “Frequency of event reporting” and the dimension “Feedback and communication about error” were combined into the variable “incident culture”, score 1 - 5. A positive score was defined as ≥ 4.0. This study included 631 health care personnel. The mean score for the incident culture was 3.10 (SD 0.65) with significant differences between the clinics, and the hospitals. The strongest predictors for the incident culture were the dimensions “Communication openness” (linear regression slope B 0.470; 95% CI 0.398 to 0.543; p < 0.001), “Manager expectations and actions promoting safety” (B 0.378; 95% CI 0.304 to 0.453; p < 0.001), “Organisational learning and continuous improvement” (B 0.374; 95% CI 0.293 to 0.455; p < 0.001) and “Teamwork across hospital units” (B 0.360; 95% CI 0.261 to 0.459; p < 0.001). In this study, the incident culture needed improvements. To improve the incident culture, the attention may be directed towards developing and maintaining a culture of open communication, management that promotes safety, and a learning organisation and teamwork between the units.
Cite this paper
Vifladt, A. , Simonsen, B. , Lydersen, S. and Farup, P. (2015) The Culture of Incident Reporting and Feedback: A Cross-Sectional Study in a Hospital Setting. Open Journal of Nursing, 5, 1042-1052. doi: 10.4236/ojn.2015.511111.
Vifladt, A. , Simonsen, B. , Lydersen, S. and Farup, P. (2015) The Culture of Incident Reporting and Feedback: A Cross-Sectional Study in a Hospital Setting. Open Journal of Nursing, 5, 1042-1052. doi: 10.4236/ojn.2015.511111.
References
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http://www.who.int/patientsafety/taxonomy/icps_full_report.pdf [2] WHO (2005) WHO Draft Guidelines for Adverse Event Reporting and Learning Systems: From Information to Action. World Health Organization, World Alliance for Patient Safety. [3] Kohn, L.T., Corrigan, J.M. and Donaldson, M.S. (2000) Executive Summary. In: Kohn, L.T., Corrigan, J.M., Donaldson, M.S., Eds., To Err Is Human: Building a Safer Health System, Institute of Medicine, National Academy Press, Washington DC, 1-16. [4] Sari, A.B., Sheldon, T.A., Cracknell, A. and Turnbull, A. (2007) Sensitivity of Routine System for Reporting Patient Safety Incidents in an NHS Hospital: Retrospective Patient Case Note Review. BMJ, 334, 79.
http://dx.doi.org/10.1136/bmj.39031.507153.AE [5] Pfeiffer, Y., Manser, T. and Wehner, T. (2010) Conceptualising Barriers to Incident Reporting: A Psychological Framework. Quality & Safety in Health Care, 19, e60.
http://dx.doi.org/10.1136/qshc.2008.030445 [6] Edmondson, A.C. (2004) Learning from Failure in Health Care: Frequent Opportunities, Pervasive Barriers. Quality & Safety in Health Care, 13, ii3-ii9.
http://dx.doi.org/10.1136/qshc.2003.009597 [7] EUNetPaS (2010) Use of Patient Safety Culture Instruments and Recommendations.
http://www.pasq.eu/DesktopModules/BlinkQuestionnaires/QFiles/448_WP4_REPORT%20%20Use%20
of%20%20PSCI%20and%20recommandations%20-%20March%20%202010.pdf [8] Colla, J.B., Bracken, A.C., Kinney, L.M. and Weeks, W.B. (2005) Measuring Patient Safety Climate: A Review of Surveys. Quality & Safety in Health Care, 14, 364-366.
http://dx.doi.org/10.1136/qshc.2005.014217 [9] Flin, R., Burns, C., Mearns, K., Yule, S. and Robertson, E.M. (2006) Measuring Safety Climate in Health Care. Quality & Safety in Health Care, 15, 109-115. http://dx.doi.org/10.1136/qshc.2005.014761 [10] Sorra, J.S. and Nieva, V.F. (2004) Hospital Survey on Patient Safety Culture (Prepared by Westat, under Contract No.290-96-0004).
http://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/hospital/resources/hospcult.pdf [11] Haugen, A.S., Softeland, E., Eide, G.E., Nortvedt, M.W., Aase, K. and Harthug, S. (2010) Patient Safety in Surgical Environments: Cross-Countries Comparison of Psychometric Properties and Results of the Norwegian Version of the Hospital Survey on Patient Safety. BMC Health Services Research, 10, 279.
http://dx.doi.org/10.1186/1472-6963-10-279 [12] Olsen, E. (2007) Workers’ Perception of Safety Culture at a Hospital. Tidsskrift for den Norske Lægeforening, 127, 2656-2660. [13] Ballangrud, R., Hedelin, B. and Hall-Lord, M.L. (2012) Nurses’ Perceptions of Patient Safety Climate in Intensive Care Units: A Cross-Sectional Study. Intensive and Critical Care Nursing, 28, 344-354.
http://dx.doi.org/10.1016/j.iccn.2012.01.001 [14] Nordin, A., Wilde-Larsson, B., Nordstrom, G. and Theander, K. (2013) Swedish Hospital Survey on Patient Safety Culture-Psychometric Properties and Health Care Staff’s Perception. Open Journal of Nursing, 3, 41-50.
http://dx.doi.org/10.4236/ojn.2013.38A006 [15] Hellings, J., Schrooten, W., Klazinga, N. and Vleugels, A. (2007) Challenging Patient Safety Culture: Survey Results. International Journal of Health Care Quality Assurance, 20, 620-632.
http://dx.doi.org/10.1108/09526860710822752 [16] Wagner, C., Smits, M., Sorra, J. and Huang, C.C. (2013) Assessing Patient Safety Culture in Hospitals across Countries. International Journal for Quality in Health Care, 25, 213-221.
http://dx.doi.org/10.1093/intqhc/mzt024 [17] Vlayen, A., Hellings, J., Claes, N., Peleman, H. and Schrooten, W. (2012) A Nationwide Hospital Survey on Patient Safety Culture in Belgian Hospitals: Setting Priorities at the Launch of a 5-Year Patient Safety Plan. BMJ Quality and Safety, 21, 760-767.
http://dx.doi.org/10.1136/bmjqs-2011-051607 [18] Smits, M., Wagner, C., Spreeuwenberg, P., van der Wal, G. and Groenewegen, P.P. (2009) Measuring Patient Safety Culture: An Assessment of the Clustering of Responses at Unit Level and Hospital Level. Quality & Safety in Health Care, 18, 292-296.
http://dx.doi.org/10.1136/qshc.2007.025965 [19] Pfeiffer, Y. and Manser, T. (2010) Development of the German Version of the Hospital Survey on Patient Safety Culture: Dimensionality and Psychometric Properties. Safety Science, 48, 1452-1462.
http://dx.doi.org/10.1016/j.ssci.2010.07.002 [20] Turunen, H., Partanen, P., Kvist, T., Miettinen, M. and Vehvilainen-Julkunen, K. (2013) Patient Safety Culture in Acute Care: A Web-Based Survey of Nurse Managers’ and Registered Nurses’ Views in Four Finnish Hospitals. International Journal of Nursing Practice, 19, 609-617.
http://dx.doi.org/10.1111/ijn.12112 [21] Nieva, V.F. and Sorra, J. (2003) Safety Culture Assessment: A Tool for Improving Patient Safety in Healthcare Organizations. Quality & Safety in Health Care, 12, ii17-ii23.
http://dx.doi.org/10.1136/qhc.12.suppl_2.ii17 [22] Olsen, E. (2008) Reliability and Validity of the Hospital Survey on Patient Safety Culture at a Norwegian Hospital. In: Oevretveit, J. and Sousa, P.J., Eds., Quality and Safety Improvement Research: Methods and Research Practice from the International Quality Improvement Research Network, National School of Public Health, Lisbon, 173-186. [23] Pronovost, P.J., Goeschel, C.A., Marsteller, J.A., Sexton, J.B., Pham, J.C. and Berenholtz, S.M. (2009) Framework for Patient Safety Research and Improvement. Circulation, 119, 330-337.
http://dx.doi.org/10.1161/CIRCULATIONAHA.107.729848 [24] Patterson, M.E., Pace, H.A. and Fincham, J.E. (2013) Associations between Communication Climate and the Frequency of Medical Error Reporting among Pharmacists within an Inpatient Setting. Journal of Patient Safety, 9, 129-133.
http://dx.doi.org/10.1097/PTS.0b013e318281edcb [25] Rashed, A. and Hamdan, M. (2015) Physicians’ and Nurses’ Perceptions of and Attitudes toward Incident Reporting in Palestinian Hospitals. Journal of Patient Safety.
http://dx.doi.org/10.1097/PTS.0000000000000218 [26] Evans, S., Berry, J., Smith, B., Esterman, A., Selim, P., O’Shaughnessy, J., et al. (2006) Attitudes and Barriers to Incident Reporting: A Collaborative Hospital Study. Quality & Safety in Health Care, 15, 39-43.
http://dx.doi.org/10.1136/qshc.2004.012559 [27] Westrum, R. (2004) A Typology of Organisational Cultures. Quality & Safety in Health Care, 13, ii22-ii27.
http://dx.doi.org/10.1136/qshc.2003.009522 [28] Saastad, E. and Flesland, O. (2015) Årsrapport 2014 for meldeordningen for uønskede hendelser i spesialisthelset-jenesten [Annual Report 2014. Adverse Events Reported from the Specialist Health Services to the Patient Safety Reporting and Learning Systems Unit]. The Norwegian Knowledge Center for the Health Services, Oslo.
http://www.kunnskapssenteret.no/publikasjoner/arsrapport-2014-for-meldeordningen-for-uonskede-
hendelser-i-spesialisthelsetjenesten [29] Snijders, C., Kollen, B.J., van Lingen, R.A., Fetter, W.P. and Molendijk, H. (2009) Which Aspects of Safety Culture Predict Incident Reporting Behavior in Neonatal Intensive Care Units? A Multilevel Analysis. Critical Care Medicine, 37, 61-67.
http://dx.doi.org/10.1097/CCM.0b013e31819300e4 [30] Leape, L.L. (2002) Reporting of Adverse Events. The New England Journal of Medicine, 347, 1633-1638.
http://dx.doi.org/10.1056/NEJMNEJMhpr011493 [31] Polit, D. and Beck, C. (2012) Data Collection in Quantitative Research. In: Polit, D. and Beck, C., Eds. Nursing Research, Generating and Assessing Evidence for Nursing Practice, 9th Edition, Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, 293-327.
[1] WHO (2009) More than Words. Conceptual Framework for the International Classification for Patient Safety. Version 1.1. Final Technical Report 2009. World Health Organization, World Alliance for Patient Safety.
http://www.who.int/patientsafety/taxonomy/icps_full_report.pdf [2] WHO (2005) WHO Draft Guidelines for Adverse Event Reporting and Learning Systems: From Information to Action. World Health Organization, World Alliance for Patient Safety. [3] Kohn, L.T., Corrigan, J.M. and Donaldson, M.S. (2000) Executive Summary. In: Kohn, L.T., Corrigan, J.M., Donaldson, M.S., Eds., To Err Is Human: Building a Safer Health System, Institute of Medicine, National Academy Press, Washington DC, 1-16. [4] Sari, A.B., Sheldon, T.A., Cracknell, A. and Turnbull, A. (2007) Sensitivity of Routine System for Reporting Patient Safety Incidents in an NHS Hospital: Retrospective Patient Case Note Review. BMJ, 334, 79.
http://dx.doi.org/10.1136/bmj.39031.507153.AE [5] Pfeiffer, Y., Manser, T. and Wehner, T. (2010) Conceptualising Barriers to Incident Reporting: A Psychological Framework. Quality & Safety in Health Care, 19, e60.
http://dx.doi.org/10.1136/qshc.2008.030445 [6] Edmondson, A.C. (2004) Learning from Failure in Health Care: Frequent Opportunities, Pervasive Barriers. Quality & Safety in Health Care, 13, ii3-ii9.
http://dx.doi.org/10.1136/qshc.2003.009597 [7] EUNetPaS (2010) Use of Patient Safety Culture Instruments and Recommendations.
http://www.pasq.eu/DesktopModules/BlinkQuestionnaires/QFiles/448_WP4_REPORT%20%20Use%20
of%20%20PSCI%20and%20recommandations%20-%20March%20%202010.pdf [8] Colla, J.B., Bracken, A.C., Kinney, L.M. and Weeks, W.B. (2005) Measuring Patient Safety Climate: A Review of Surveys. Quality & Safety in Health Care, 14, 364-366.
http://dx.doi.org/10.1136/qshc.2005.014217 [9] Flin, R., Burns, C., Mearns, K., Yule, S. and Robertson, E.M. (2006) Measuring Safety Climate in Health Care. Quality & Safety in Health Care, 15, 109-115. http://dx.doi.org/10.1136/qshc.2005.014761 [10] Sorra, J.S. and Nieva, V.F. (2004) Hospital Survey on Patient Safety Culture (Prepared by Westat, under Contract No.290-96-0004).
http://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/hospital/resources/hospcult.pdf [11] Haugen, A.S., Softeland, E., Eide, G.E., Nortvedt, M.W., Aase, K. and Harthug, S. (2010) Patient Safety in Surgical Environments: Cross-Countries Comparison of Psychometric Properties and Results of the Norwegian Version of the Hospital Survey on Patient Safety. BMC Health Services Research, 10, 279.
http://dx.doi.org/10.1186/1472-6963-10-279 [12] Olsen, E. (2007) Workers’ Perception of Safety Culture at a Hospital. Tidsskrift for den Norske Lægeforening, 127, 2656-2660. [13] Ballangrud, R., Hedelin, B. and Hall-Lord, M.L. (2012) Nurses’ Perceptions of Patient Safety Climate in Intensive Care Units: A Cross-Sectional Study. Intensive and Critical Care Nursing, 28, 344-354.
http://dx.doi.org/10.1016/j.iccn.2012.01.001 [14] Nordin, A., Wilde-Larsson, B., Nordstrom, G. and Theander, K. (2013) Swedish Hospital Survey on Patient Safety Culture-Psychometric Properties and Health Care Staff’s Perception. Open Journal of Nursing, 3, 41-50.
http://dx.doi.org/10.4236/ojn.2013.38A006 [15] Hellings, J., Schrooten, W., Klazinga, N. and Vleugels, A. (2007) Challenging Patient Safety Culture: Survey Results. International Journal of Health Care Quality Assurance, 20, 620-632.
http://dx.doi.org/10.1108/09526860710822752 [16] Wagner, C., Smits, M., Sorra, J. and Huang, C.C. (2013) Assessing Patient Safety Culture in Hospitals across Countries. International Journal for Quality in Health Care, 25, 213-221.
http://dx.doi.org/10.1093/intqhc/mzt024 [17] Vlayen, A., Hellings, J., Claes, N., Peleman, H. and Schrooten, W. (2012) A Nationwide Hospital Survey on Patient Safety Culture in Belgian Hospitals: Setting Priorities at the Launch of a 5-Year Patient Safety Plan. BMJ Quality and Safety, 21, 760-767.
http://dx.doi.org/10.1136/bmjqs-2011-051607 [18] Smits, M., Wagner, C., Spreeuwenberg, P., van der Wal, G. and Groenewegen, P.P. (2009) Measuring Patient Safety Culture: An Assessment of the Clustering of Responses at Unit Level and Hospital Level. Quality & Safety in Health Care, 18, 292-296.
http://dx.doi.org/10.1136/qshc.2007.025965 [19] Pfeiffer, Y. and Manser, T. (2010) Development of the German Version of the Hospital Survey on Patient Safety Culture: Dimensionality and Psychometric Properties. Safety Science, 48, 1452-1462.
http://dx.doi.org/10.1016/j.ssci.2010.07.002 [20] Turunen, H., Partanen, P., Kvist, T., Miettinen, M. and Vehvilainen-Julkunen, K. (2013) Patient Safety Culture in Acute Care: A Web-Based Survey of Nurse Managers’ and Registered Nurses’ Views in Four Finnish Hospitals. International Journal of Nursing Practice, 19, 609-617.
http://dx.doi.org/10.1111/ijn.12112 [21] Nieva, V.F. and Sorra, J. (2003) Safety Culture Assessment: A Tool for Improving Patient Safety in Healthcare Organizations. Quality & Safety in Health Care, 12, ii17-ii23.
http://dx.doi.org/10.1136/qhc.12.suppl_2.ii17 [22] Olsen, E. (2008) Reliability and Validity of the Hospital Survey on Patient Safety Culture at a Norwegian Hospital. In: Oevretveit, J. and Sousa, P.J., Eds., Quality and Safety Improvement Research: Methods and Research Practice from the International Quality Improvement Research Network, National School of Public Health, Lisbon, 173-186. [23] Pronovost, P.J., Goeschel, C.A., Marsteller, J.A., Sexton, J.B., Pham, J.C. and Berenholtz, S.M. (2009) Framework for Patient Safety Research and Improvement. Circulation, 119, 330-337.
http://dx.doi.org/10.1161/CIRCULATIONAHA.107.729848 [24] Patterson, M.E., Pace, H.A. and Fincham, J.E. (2013) Associations between Communication Climate and the Frequency of Medical Error Reporting among Pharmacists within an Inpatient Setting. Journal of Patient Safety, 9, 129-133.
http://dx.doi.org/10.1097/PTS.0b013e318281edcb [25] Rashed, A. and Hamdan, M. (2015) Physicians’ and Nurses’ Perceptions of and Attitudes toward Incident Reporting in Palestinian Hospitals. Journal of Patient Safety.
http://dx.doi.org/10.1097/PTS.0000000000000218 [26] Evans, S., Berry, J., Smith, B., Esterman, A., Selim, P., O’Shaughnessy, J., et al. (2006) Attitudes and Barriers to Incident Reporting: A Collaborative Hospital Study. Quality & Safety in Health Care, 15, 39-43.
http://dx.doi.org/10.1136/qshc.2004.012559 [27] Westrum, R. (2004) A Typology of Organisational Cultures. Quality & Safety in Health Care, 13, ii22-ii27.
http://dx.doi.org/10.1136/qshc.2003.009522 [28] Saastad, E. and Flesland, O. (2015) Årsrapport 2014 for meldeordningen for uønskede hendelser i spesialisthelset-jenesten [Annual Report 2014. Adverse Events Reported from the Specialist Health Services to the Patient Safety Reporting and Learning Systems Unit]. The Norwegian Knowledge Center for the Health Services, Oslo.
http://www.kunnskapssenteret.no/publikasjoner/arsrapport-2014-for-meldeordningen-for-uonskede-
hendelser-i-spesialisthelsetjenesten [29] Snijders, C., Kollen, B.J., van Lingen, R.A., Fetter, W.P. and Molendijk, H. (2009) Which Aspects of Safety Culture Predict Incident Reporting Behavior in Neonatal Intensive Care Units? A Multilevel Analysis. Critical Care Medicine, 37, 61-67.
http://dx.doi.org/10.1097/CCM.0b013e31819300e4 [30] Leape, L.L. (2002) Reporting of Adverse Events. The New England Journal of Medicine, 347, 1633-1638.
http://dx.doi.org/10.1056/NEJMNEJMhpr011493 [31] Polit, D. and Beck, C. (2012) Data Collection in Quantitative Research. In: Polit, D. and Beck, C., Eds. Nursing Research, Generating and Assessing Evidence for Nursing Practice, 9th Edition, Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, 293-327.