Attitudes of doctors and nurses towards incident reporting: a qualitative analysis.

OBJECTIVES (i) To examine attitudes of medical and nursing staff towards reporting incidents (adverse events and near-misses), and (ii) to identify measures to facilitate incident reporting. DESIGN Qualitative study. In March 2002, semistructured questions were administered to five focus groups--one each for consultants, registrars, resident medical officers, senior nurses, and junior nurses. PARTICIPANTS AND SETTING 14 medical and 19 nursing staff recruited using purposive sampling from three metropolitan public hospitals in Adelaide, South Australia. MAIN OUTCOME MEASURES Attitudes and barriers to incident reporting; differences in reporting behaviour between disciplines; how to facilitate incident reporting. RESULTS Cultural differences between doctors and nurses, identified using Triandis' theory of social behaviour, were found to underpin attitudes to incident reporting. Nurses reported more habitually than doctors due to a culture which provided directives, protocols and the notion of security, whereas the medical culture was less transparent, favoured dealing with incidents "in-house" and was less reliant on directives. Common barriers to reporting incidents included time constraints, unsatisfactory processes, deficiencies in knowledge, cultural norms, inadequate feedback, beliefs about risk, and a perceived lack of value in the process. CONCLUSIONS Strategies to improve incident reporting must address cultural issues.