Patient Safety Reporting Systems and Surgical Safety Culture: One Culture to Rule Them All?

Safety event reporting is considered a marker of a positive safety culture, and many institutions have implemented efforts to increase reporting rates. Less is understood about the relationship between reporting behaviors and the surrounding safety culture. The aim of this study is to explore similarities and differences in the behaviors and attitudes expressed by surgical faculty, residents, and nurses regarding safety event reporting, thereby exploring the underlying safety culture in each group.

Semi-structured interviews were conducted with 41 individuals involved in surgical care at a single high-volume academic center, distributed among surgical residents, faculty, and nurses. The in-depth, semi-structured interviews included open-ended questions with targeted follow-up probing. Interviews were audio-recorded, de-identified, and transcribed verbatim. Content analysis was used to identify relevant behaviors and attitudes.

Residents, faculty, and nurses described distinct patterns of behaviors around the reporting system, with nurses describing the most consistent use and faculty the least. All 3 groups expressed mixed attitudes toward reporting, describing perceived conflict between the formal processes of reporting and a more traditional face-to-face approach to handling safety incidents. Residents described a wide range of attitudes, while nurses most consistently articulated how reporting could effect positive change.

Examination of subgroup behaviors and attitudes regarding patient safety reporting reveals substantive differences in underlying safety culture. Understanding these differences can help institutions interested in improving reporting behaviors as well as the underlying safety culture itself.