Physician perception of hospital safety and barriers to incident reporting.

Background: Despite increased attention to patient safety in recent years, physician involvement in hospital safety activities appears to have remained limited.

Methods: An anonymous survey of internal medicine housestaff and faculty physicians at an academic medical center assessed safety reporting behavior and witnessed adverse events or near misses.

Results: Although 65% of the 120 physicians responding (56% response rate) had not made any adverse event or near miss reports in the prior year, 60% had witnessed at least three adverse events or near misses. Uncertainty about reporting needs and mechanisms, concern about time required, perceived clinical import of the event in question, and lack of physician involvement in the system were all important reasons for failure to report. Concern about being blamed or judged less competent or similar consequences to others were considered less important barriers to reporting. The perceived degree of reporting barriers (p = .01) and number of witnessed adverse events or near misses (p = .005) were independently negatively associated with respondents' perception of safety. Most (58%) physicians expressed willingness to participate in the hospital safety process actively if requested.

Discussion: Physicians' barriers to safety reporting in an academic medical center are negatively associated with their perception of hospital safety. These barriers are remediable, and most physicians appear amenable to increased participation in the hospital safety process.