INTRODUCTION: Reporting medical errors is a major challenge in patient safety and improving service quality. The purpose of the present study is to investigate the status of error reporting and the challenges of developing an error-reporting system in Iran. METHODS: This study was designed with qualitative approach and grounded theory method in teaching hospitals affiliated to Iran University of Medical Sciences. The views of safety authorities at various levels of management, including those responsible for safety at the Ministry of Health, Vice Chancellor and Hospitals affiliated to Iran University of Medical Sciences, were investigated in 2019 regarding adverse events. RESULTS: Four major themes were identified included iceberg reporting and disclosure, weak reporting, underreporting, and non-error disclosure. The most common problems in reporting medical error were non-involvement of physicians in the error-reporting process, structural (human and information) bugs in root cause analysis sessions, and defective error prevention approaches designed based on the failure mode and effects analysis. DISCUSSION: Despite a large number of medical errors occurred in health-care settings, error reporting is still very low, with only a limited number of errors being reported routinely in hospitals and the rest are minor and occasional reports. CONCLUSION: Creating a mandatory error-reporting system and requiring physicians to report and participate in error analysis sessions can create a safety culture and increase the error-reporting rate.

Background: Safety culture is the basis and dominant part of patient's safety, and is considered as the main axis of safety promotion programs and service quality. The purpose of this study was to explain the challenges of safety culture in Iranian educational centers with a qualitative approach. Methods: This study was a contractual qualitative content analysis which conducted in 1400. The study population consisted of people who had 5 years of experience in taking care patient or working in the patient's safety and quality control unit in teaching and medical centers affiliated to Tehran University of Medical Sciences. Study data were saturated by purposeful snowball sampling and in-depth and semi-structured interviews with 25 participants. “Granheim and Landman approaches” and “Goba and Lincoln criteria” were used to analyze the data and solidify the research. The process of coding and analyzing research data was performed simultaneously; Finally, the extracted categories and subcategories were confirmed by the interviewees. MaxQDA 10 was used to analyze data. Results: By analyzing the interviews, 331 codes, 7 categories and 20 subcategories were extracted. Lack of reporting errors, poor culture regarding no-blame, staffing issues, low understanding of patient safety, poor management support for patient safety, poor teamwork between units, and lack of open organizational communication were the main categories found and the most important challenges of safety culture in teaching and medical hospitals. Conclusion: According to the findings of the research, developing codified and continuous educational programs, strengthening teamwork and communication, adopting a comprehensive approach to increase the presence of all members of the treatment team in the process of reporting, and analyzing and implementing error prevention programs are among the requirements for improving and promoting the safety culture and quality of service to patients.

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