Researchers: Tal Katz-Navon¹, Eitan Naveh², Zvi Stern³, Osnat Lev-Zion Korach³, Micky Gross⁴

Background: In order to avoid errors and improve patient safety and quality of care, hospitals need to identify the sources of failures and facilitate implementation of corrective actions. Hence, hospitals try to collect reports and data about errors by investing enormous resources in reporting systems. However, despite hospitals’ declared goal of increasing the voluntary reporting of errors, the problem of underreporting of adverse events remains.

Objectives: To understand the antecedents of staff members’ willingness to report errors. To explore a complex system of considerations staff uses when deciding whether to report their errors or be silent about them.

Method: We surveyed the hospitals staff and collected archival data. 298 staff members from of 30 wards participated.

Findings: Results of hierarchical regression analyses revealed that when staff members believe they have discretion (1) the higher the perceived procedures suitability, the more staff members follow procedures, and (2) flowing procedures increases error reporting. However, when staff members believe they do not have discretion, (3) perceived procedures suitability is not associated with following procedures, and (4) following procedures is now associated with error reporting.

Conclusions: Health care organizations develop and maintain quality assessment and performance improvement programs in which they track medical errors and adverse patient events, analyze their causes, and implement preventive actions and mechanisms that include feedback and learning throughout the organization. To accomplish this, health care organization must measure, analyze, and track quality indicators, including adverse patient events and other aspects of performance that assess processes of care, service, and operations. Specifically to this study results, organizations may influence following procedures through staff members perceptions that they are expected to use discretion and through level of standardizations that is perceived as suitable for daily work by the staff.

Recommendations: Medical teams must be convinced that they are expected to exercise discretion. When the medical staff perceive that there is excess in standardization, it is harmful to the execution of the standardization. To increase compliance with rules and procedures, standardization needs to be set to the least possible. Sometimes it goes against the tendency to add more procedures and standardization to control the daily work of the team. Decision makers responsible for determining the rules by which the system functions should acknowledge that medical personnel dealing with complex everyday reality, choose and decide to what extent they comply with the procedures set. Our findings suggest that decision makers should not to contest against this phenomenon, but should encourage it.

Research end date: 01/2017