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Study: Encouraging Incident Reporting Leads to Improved Safety Culture

Nov. 1, 2012
A new study focusing on the effects of incident reporting within a radiation oncology department suggests that encouraging reporting of errors and incidents can improve safety measures, safety performance and employees’ perceptions of safety.

When a system is in place that encourages the continuous reporting of incidents by all staff, the safety culture and performance at the worksite may improve, according to researchers at the Perelman School of Medicine at the University of Pennsylvania, who implemented a Conditions Reporting System in the facility's radiation oncology department as part of the study.

The study shows that “the workflow process is a key factor to determining safety and quality,” according to Amit Maity, M.D., Ph.D., associate professor of radiation oncology in the Perelman School of Medicine at the University of Pennsylvania and one of the study authors.

“To examine the safety culture and incident reporting process across our department, our team implemented a Conditions Reporting System that would ensure the continuous examination of any incidents,” Maity said. “By utilizing the program, we learn from all reported events, and are able to develop improved safety measures that help us deliver the highest-quality patient care.”

For the duration of the yearlong study, staff in all divisions and across all steps in the radiation oncology workflow participated in reporting incidents. Maity and other researchers measured safety culture using the AHRQ Patient Safety Culture Survey – a tool commonly used to assess the safety culture of a hospital or specific unit within a hospital over time. Comparing survey results at the onset of the study to those gathered a year later, the team saw improvements in 11 of the 13 categories pertaining to a safe and open environment.

Study results also showed an increasingly open and healthy culture and improved responses to staff surveys focused on safety.

“By providing a conditions reporting program and encouraging our entire staff to be part of the process of improving patient safety, we’re reinforcing that safety is a top priority,” said Stephen M. Hahn, M.D., Henry K. Pancoast Professor of Radiation Oncology, and chair of the Department of Radiation Oncology at the Perelman School of Medicine at the University of Pennsylvania. “Ultimately, by reporting and investigating incidents, our faculty and staff are more confident in the care they provide and we’re better able to identify any holes in our processes. Moving forward, we hope these systems will aid in preventing adverse events.”

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