Reporting errors helps trusts to spot problems early on. How can you persuade staff to open up? Alison Moore finds out

Knowing when you have made a mistake and learning from the experience is vital to improving safety in the NHS – but getting staff to report mistakes is not always easy. They may see reporting as snitching on others, as opening themselves to blame or as not welcome, or they may think it is not acted on.

Yet trusts with a high level of reporting are likely to spot problems early on and to react to them; far from suggesting the trust is less safe, it can mean it has a strong safety culture. Near-miss reporting, where incidents have not led to harm but could have, is particularly valuable.

National Patient Safety Agency chief executive Martin Fletcher says: “Good reporting is the cornerstone of good patient safety. If you don’t know what is going on, you don’t know what to fix.”

The agency and the NHS Confederation have recently worked together to find out which factors make high-reporting trusts stand out. They highlight five common factors that could be taken on board by other organisations:

Give staff feedback They need to see that reporting an incident or a near miss does lead to action or change; otherwise their motivation to report will drop off and it will be seen as a bureaucratic process.

Acknowledging reports when they are made is one simple step but more general feedback showing the results of reporting is also important. For example, newsletters can highlight incidents which have led to action; reports to departments or wards can highlight local issues; and patient safety teams and “champions” can give feedback.

“The response is always more important than the reporting system. There is no point in collating reports if you don’t do anything about them,” says Mr Fletcher.

Focus on learning Lessons from incidents should be taken in, with the focus on root cause analysis and action to reduce risks to patients, rather than blame.

Clusters of incidents can pinpoint areas that need extra training, additional equipment or changes
in practice.

Staff can see how reporting influences decisions and changes practice; this is important to keep them motivated. “We know that blame drives problems underground. People who are worried about getting into trouble for raising concerns are just not going to do it,” says Mr Fletcher. He advocates an open culture where problems are investigated fairly.

Engage frontline staff Staff in trusts with high levels of reporting know how to report and feel supported. Training on how to report can be important. Some organisations have appointed safety champions at various levels, which can increase reporting.

“Patient safety is one of the areas where you really need everybody in healthcare feeling it is their responsibility,” says Mr Fletcher. “One of the things we have tried to encourage is that reporting systems in trusts should encourage anyone who has concerns about something that did or could affect patient safety reports it.”

Using the parallel of the aviation industry, he says there are cases where cabin crew notice things that pilots have not that affects safety: it is an environment where people at every level can raise those concerns that will contribute to safety.

Make it easy to report Reporting needs to be made as easy as possible for staff – and, although computer based systems are useful, some staff may have limited access to computers and will need a paper based system as an option.

Reporting that fits easily into busy working lives may be more effective; for example, a form on drug trolleys for immediate reporting of medication errors.

Make reporting matter Leadership on safety from the board and the senior management is important. This may mean investing in systems which support decision making at the highest level.

High-reporting organisations often bring together data on incidents with other sources to identify major risks. For example infection control can combine surveillance data, reporting incidents, investigations and complaints.

High levels of reporting can bring benefits. This can be an indicator of a strong safety culture throughout the organisation and can be associated with high NHS Litigation Authority ratings. North Tees and Hartlepool foundation trust has found investment in staff training and encouragement of reporting has been associated with halving claims against the trust. This has been attributed to the trust identifying and rectifying problems at an early stage.

The Healthcare Commission also looks at consistent reporting as evidence that a trust is meeting its core safety standards.

Within the health service, the value of high reporting is beginning to be recognised. Mr Fletcher says the trend is upwards.

“We continue to get more reports and continue to get more trusts reporting regularly as well. Last quarter more than 90 per cent of trusts reported,” he says.

Manage the message

But the wider public and the media may not understand this. The NHS Confederation suggests trusts need to think carefully about how to manage the message that the organisation has a high level of reporting, both with staff and with the media and public.

“As a patient you are probably better off looking at a trust with high reporting,” says Mr Fletcher. “If you have good reporting, you are much more likely to have a better understanding of the risks to patient safety – especially if you can get people to do near-miss reporting.”

But it also creates organisations where concerns are raised and action taken and this contributes to a sense that staff are valued and what they see and do matters.

“I think it has a benefit for the whole working environment. People have a sense that if problems are raised, then something will happen. In the long term it is in the interests of making patient care as safe as possible for all patients. You can’t make it risk free but you can use reporting to make it as safe as possible.”

Find out more

Act on Reporting, a briefing on the experiences of 20 high-reporting trusts.

www.nhsconfed.org

National Patient Safety Agency

www.npsa.nhs.uk

The next article in this series on good reporting will appear on 22 January.