Attitudes of doctors and nurses towards incident reporting: a qualitative analysis

OBJECTIVES: (i) To examine attitudes of medical and nursing staff towards reporting incidents (adverse events and near-misses), and (ii) to identify measures to facilitate incident reporting. DESIGN: Qualitative study. In March 2002, semistructured questions were administered to five focus groups--one each for consultants, registrars, resident medical officers, senior nurses, and junior nurses. PARTICIPANTS AND SETTING: 14 medical and 19 nursing staff recruited using purposive sampling from three metropolitan public hospitals in Adelaide, South Australia. MAIN OUTCOME MEASURES: Attitudes and barriers to incident reporting; differences in reporting behaviour between disciplines; how to facilitate incident reporting. RESULTS: Cultural differences between doctors and nurses, identified using Triandis' theory of social behaviour, were found to underpin attitudes to incident reporting. Nurses reported more habitually than doctors due to a culture which provided directives, protocols and the notion of security, whereas the medical culture was less transparent, favoured dealing with incidents "in-house" and was less reliant on directives. Common barriers to reporting incidents included time constraints, unsatisfactory processes, deficiencies in knowledge, cultural norms, inadequate feedback, beliefs about risk, and a perceived lack of value in the process. CONCLUSIONS: Strategies to improve incident reporting must address cultural issues.