Abstract
This research is a qualitative study of barriers to incident reporting at The Christie NHS Foundation Trust (The Christie). The conceptual framework was based on models such as the cultural web and Senge (fifth discipline). The E-V-R congruence model formed the basis of the framework and includes identified barriers to incident reporting from the literature review. The following barriers were identified from the literature: a lack of clarity about what to report, lack of anonymity, no feedback, a culture of blame and fear.
The research methodology employed a number of different research methods to achieve triangulation and to ensure the reliability and validity of the research. Methodologies included the use of self-completion questionnaires, semi-structured interviews and secondary data taken from the NHS National Staff Survey, 2008.
Using the conceptual framework a number of barriers to incident reporting were identified at The Christie. These barriers include:
- Staff are too busy to report incidents - A lack of clarity about what to report - Staff find it difficult to report senior members of staff - A lack of feedback - The form takes too long to complete It was also established that there is a 'fair blame' culture at The Christie, and that there is a lack of learning from incidents.
The following recommendations were made:
- Raise awareness of incident reporting and provide clear guidelines on what constitutes a reportable incident.
- Introduce a feedback mechanism that links the original reporter to an incident.
- Communicate the changes that result from incidents and improve the communication process across the Trust.
- Review the incident report form (IRF) and make it easier to complete.
- Introduce a web based incident reporting system.
- Introduction of a confidential helpline linked to the Governance team - Develop an incident reporting training package