Background: January 2004, marked the commencement date of the Danish Act on Patient Safety in the Danish Health Care System, which made it mandatory, by law, for all health care professionals to report (potential) adverse events, by means of the national reporting system. The aim of the act and the national reporting system is to improve patient safety, throughout the Danish health care system, by analyzing adverse event reports in a learning perspective. However, ten years after the official commencement date, media have argued that the Danish health care system, have not been learning from their mistakes, as Danish media reports numbers showing that adverse events are being reported as frequent today, as they were in 2004. This argument, presented by Danish media, led to the discovery that not only do different health care institutions have varying reporting frequencies of adverse events, but the same trend can be found within individual health care institutions, between departments. Initial contact with the North Jutland Region’s regional quality committee, confirmed having observed this variance and were curious as to the cause of such discrepancy in reporting. In turn, leading to the design of present study.
Objective: To investigate discrepancies in reporting frequencies of (potential) adverse events, at two different yet comparable internal medical wards, within the same hospital organization, in Denmark. As well as to identify parameters both supporting and impeding health care professionals from reporting (potential) adverse events, in said internal medical wards.
Methods: Ethnographic study of two internal medical wards. The empirical data collection follow four stages of observations ranging from initial descriptive observations to focused and selective observations. Data was collected through participant observations, participant reports, formal and informal interviews, as well as field notes for recording observations, reports and key areas of interest for further observations.
Participants and setting: All health care professionals present at the time of conducted fieldwork, here included; doctors, nurses, health care assistants and associated students. All participants were employed in different departments and wards, within the same hospital organization. The two wards in focus were different, yet comparable internal medical wards with discernable differences in reporting frequencies of adverse events.
Results: Three main parameters were discovered throughout the conducted ethnographic fieldwork. Prioritization of tasks, Evaluation of adverse events’ severity-level and interpersonal relationships. Analysis of the three parameters, led to the discovery of several sub-parameters, as underlying supportive and impeding factors to adverse event reporting. The three parameters, as well as corresponding sub-parameters, were seen as both supportive and impeding factors in terms of health care professionals attitudes towards adverse event reporting.
Conclusions: Three main parameters, including corresponding sub-parameters, could be seen as a plausible explanation to why the selected wards were showing differing reporting frequencies of (potential) adverse events. Moreover, by contextualizing the results presented in current thesis, with results from international academic literature, indicated a need to focus on medical culture as a supportive and impeding factor in health care professionals’ attitudes towards adverse event reporting. Present thesis suggests a new perspective, to investigate how the Danish adverse event reporting system could be optimized, to take the parameters presented here, into consideration. This could provide knowledge on how the integration of adverse event reporting in the work routines of Danish health care professionals, could improve the national reporting system.