When nurses and other healthcare workers find a safety problem and fix it, they often do not take the next step and report the problem, according to a study published in BMJ Quality and Safety.
Researchers conducted interviews with 40 healthcare providers in a Canadian hospital to find out if the providers fix the problem and forget about it or fix it and report it afterward. They found that providers tend to fix and forget, rather than fix and report.
Usually, providers chose not to report a problem for the following reasons:
- The problem was a "near miss" and didn't need to be reported because no harm to the patient actually occurred
- The problem was seen as a unique or one-time event
- The problem was seen as inevitable or routine
"We found that generally healthcare providers do not prioritise reporting if a safety problem is fixed," the study concluded. "We argue that fixing and forgetting patient safety problems encountered may not serve patient safety as well as fixing and reporting. The latter approach aligns with recent calls for patient safety to be more preventive."