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Macrae highlights well-discussed challenges of using safety incident reporting systems as a source of learning and improvement in healthcare.1 Our research group has analysed over 50 000 free-text reports from primary care submitted to the England and Wales National Reporting and Learning System, and developed a mixed methods approach to identify learning from these reports.2
We agree that simply aiming for a greater number of reports to remedy problems arising from under-reporting is not desirable. There is, however, an opportunity to target specific discipline or professional groups to stimulate a culture of reporting, and efforts in anaesthetics have been commendable. From our analysis of incidents involving children in primary care3 ,4 we would advocate initiatives that promote reporting across multiple sectors, not least patient-reporting, at local and national levels. Further, encouraging reports about specific safety incident types and specific patient groups (eg, delays in treatment received by socially deprived children) would support capture of a diverse range of issues underpinning the most common or most important problems for those patients. While all incidents about all patient groups should be reported (and welcomed), targeted efforts to inform the design/redesign of improvement initiatives could start to aid buy-in from busy clinicians for future reporting.5
Macrae highlights that people reporting incidents want feedback and to see changes to improve healthcare. For organisations to identify emerging priority issues among their workforce, a means of structuring what has typically been unstructured data is needed. We empirically derived a safety classification system aligned with the WHO Classification for Patient Safety for primary care for research purposes, coded by clinicians and for the purpose of identifying improvements in clinical practice.1 Codes are combined, the most common incident types in a domain visually displayed as Pareto charts, and the most common reported causes in Ishikawa diagrams.6 Such outputs can be used to initiate conversations with healthcare professionals and organisational leads about the designs of improvement projects and for focusing case note review enquiries.
Moving forward, many of ‘the problem[s] with incident reporting’ could well be addressed by the next generation of healthcare professionals now starting to receive formal quality improvement and human factors training at health professions schools worldwide. The ‘problem[s]’ must become themselves the foci for improvement efforts, by organisations aiming to answer: How can we maximise the usefulness of data provided by staff? How can analysis of these data regularly inform our improvement agendas? How can we engage staff with data they have provided? How can we demonstrate we have acted on their concerns?
Footnotes
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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