Fix and forget or fix and report: a qualitative study of tensions at the front line of incident reporting.
Hewitt TA, Chreim S. BMJ Qual Saf. 2015 Mar 6; [Epub ahead of print].
A large body of literature shows that health care providers frequently fail to voluntarily report safety incidents. This qualitative study found that clinicians generally prefer to fix and forget safety problems rather than report them. This behavior is problematic in that it likely leads to clinicians developing workaroundsinstead of helping identify and solve underlying systems issues.
Failure to Report
Spath PL. AHRQ WebM&M [serial online]. March 2007.
Patient Safety in Canada: An Update.
Ottawa, ON, Canada: Canadian Institute for Health Information; August 14, 2007.
Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence.
Keers RN, Williams SD, Cooke J, Ashcroft DM. Ann Pharmacother. 2013;47:237-256.
COMMENTARYView all related resources...
Restoring trust in VA health care.
Kizer KW, Jha AK. N Engl J Med. 2014;371:295-297.