The Supportive and Impeding Nature of Culture in Adverse Event Reporting: - an ethnographic research study

The Supportive and Impeding Nature of Culture in Advere Event Reporting

Harter, Christopher Daniel

4. term

Techno-Anthropology, Master

2014

2014-06-04

77

Siden 2004 har det ved lov været obligatorisk for sundhedsprofessionelle i Danmark at indberette utilsigtede hændelser (fejl eller nær-hændelser, der kan skade patienter) i et nationalt system. Formålet er at lære af hændelserne og forbedre patientsikkerheden. Ti år senere rejste medierne tvivl om, hvorvidt der faktisk blev lært, da der fortsat blev indberettet omtrent lige så mange hændelser som i 2004. Samtidig varierer indberetningsfrekvensen mellem institutioner og mellem afdelinger i samme hospital. Region Nordjyllands regionale kvalitetsudvalg havde observeret denne variation og ønskede forklaringer, hvilket gav anledning til dette studie. Formål: at undersøge, hvorfor to sammenlignelige interne medicinske afdelinger i samme hospital indberetter (potentielle) utilsigtede hændelser forskelligt, samt at identificere forhold, der fremmer eller hæmmer indberetning. Metode: et etnografisk studie af to afdelinger med fire faser af observationer fra brede til fokuserede. Data blev indsamlet via deltagerobservation, deltagerberetninger, formelle og uformelle interviews samt feltnoter. Deltagere og kontekst: læger, sygeplejersker, social- og sundhedsassistenter og studerende, som var til stede under feltarbejdet i én hospitalsorganisation. Fokus var to forskellige, men sammenlignelige interne medicinske afdelinger med tydelige forskelle i indberetningsfrekvens. Resultater: Tre hovedfaktorer påvirkede indberetningen: 1) prioritering af opgaver i en travl hverdag, 2) vurdering af, hvor alvorlig en hændelse er (hvornår noget er “alvorligt nok” til at indberette), og 3) relationer og samarbejde mellem kolleger. Hver faktor omfattede underliggende forhold, som både kunne fremme og hæmme indberetning. Konklusion: De tre faktorer, med tilhørende underfaktorer, kan plausibelt forklare de forskellige indberetningsfrekvenser mellem de to afdelinger. Sammenholdt med international litteratur peger fundene på, at den medicinske kultur både kan støtte og hindre indberetning. Specialet foreslår at forbedre det nationale indberetningssystem ved at tage disse forhold i betragtning, så indberetning bliver bedre integreret i sundhedsprofessionelles arbejdsgange.

Since 2004, Danish law has required health professionals to report adverse events (errors or near misses that can harm patients) using a national system. The goal is to improve patient safety by learning from these reports. A decade later, media questioned whether learning was happening, noting that as many events were being reported as in 2004. Reporting also varies between institutions and between departments within the same hospital. The North Jutland regional quality committee had observed this variation and sought explanations, prompting this study. Aim: to examine why two comparable internal medicine wards within the same hospital report different numbers of (potential) adverse events, and to identify what helps or hinders staff from reporting. Methods: ethnographic study of two wards, moving through four stages of observation from broad to focused. Data came from participant observation, participants’ accounts, formal and informal interviews, and field notes. Participants and setting: doctors, nurses, healthcare assistants, and students present during fieldwork within a single hospital organization. The focus was on two different but comparable internal medicine wards with clear differences in reporting frequency. Results: Three main factors influenced reporting: 1) how tasks are prioritized during busy work, 2) how the severity of an event is judged (what is “serious enough” to report), and 3) interpersonal relationships and teamwork. Each factor had subfactors that could either support or discourage reporting. Conclusions: These factors plausibly explain the different reporting rates between the two wards. Considered alongside international research, the findings point to medical culture as both a support and a barrier to reporting. The thesis suggests improving the national reporting system by accounting for these factors so that reporting is better integrated into everyday work routines.

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