A qualitative study of the intra-hospital variations in incident reporting

Abstract

Objective. To determine the relationship between variations in hospital incident reporting and the corresponding attitudes and participation of medical professionals. Methods. An in-depth qualitative case study using semi-structured interviews with hospital managers and clinicians. Twelve participants were theoretically sampled based on their involvement with clinical risk management and patient safety. Twenty-five medical physicians and four risk leads were selected from the specialist hospital departments of Obstetrics, Anaesthesia, General Surgery, Acute Medicine, and Rehabilitation. The data were analysed to develop a descriptive account of the intra-hospital variations in reporting and the associated attitudes of physicians. Setting. The research was conducted in a single acute National Health Service Hospital Trust in the English Midlands. Results. The qualitative data revealed significant variations in the intra-hospital organization of incident reporting between medical specialities that corresponded with the attitudes and participation of medical staff. Specifically, it was found that medical doctors were more inclined to report incidents where the process of reporting was localized and integrated within medical rather than managerial systems of quality improvement. Underlying these variations, it is suggested that medical reporting is more likely when physicians have greater control or ownership of incident reporting, as this fosters confidence in the purpose of reporting, in particular its capacity to make meaningful service improvements whilst maintaining a sense of collegiality and professionalism. © International Society for Quality in Health Care and Oxford University Press 2004; all rights reserved.