Introducing incident reporting in primary care: a translation from safety science into medical practice

Blame the Patient, Blame the Doctor or Blame the System? A Meta-Synthesis of Qualitative Studies of Patient Safety in Primary Care

“…They looked at general practice computer systems [ 68 ], the use of electronic health records and e-prescribing [ 69 ], patient identifiers and identification at a walk-in centre [ 70 , 71 ], uncertainties in providing healthcare [ 72 ], safety systems in commercial organisations providing NHS primary care [ 73 ] and the introduction of an incident reporting system [ 74 ]. The studies were based in the UK [ 68 , 70 , 71 , 73 ], The Netherlands [ 72 , 74 ] and the USA [ 69 ]. Following appraisal, all were considered ‘acceptable’ in terms of quality of reporting of research methods, except for one which was considered ‘excellent’ [ 68 ].…”

“…Following appraisal, all were considered ‘acceptable’ in terms of quality of reporting of research methods, except for one which was considered ‘excellent’ [ 68 ]. The majority of the studies were ethnographic in nature, where the researchers carried out observations and interviews [ 70 – 74 ]. There was also an interview study with range of “key stakeholders” [ 68 ], and a focus groups study with healthcare providers [ 69 ].…”

“…Following the subset of papers concerned with staff perspectives (see above), these have been removed from Table 5 for clarity. This mainly led to the exclusion of some findings from one article which was focused on the introduction of an error reporting system [ 74 ].…”

“…A group of findings that appeared unique to this subset of studies was labelled “assumptions, illusions and uncertainties.” Characteristics of health care systems that could threaten safety centred on issues of workload and lack of resources, which have been highlighted in other subsets. Such concerns led to providers “cutting corners” and taking “potentially risky decisions” that were seen as unavoidable in the circumstances [ 74 ]. Healthcare organisations were seen as having the ability to disseminate innovations, and monitor and “performance manage” staff to improve safety.…”

“…On the other, procedures were seen as offering a false sense of security by giving providers “the illusion of knowing what safety” means [ 72 ]. As in other subsets, workload was a concern and new protocols, developed to “minimise the possibility that such an error would happen again”, created additional time pressures for providers who already didn’t have enough time to do everything [ 74 ]. There were also concerns that procedural standardisation could “eliminate errors that are not intrinsically bad” and, in doing so limit innovation that could result in better care and “the correction of a too-narrow norm” [ 72 ].…”