Mixed methods evaluation of a specialty-specific system to promote physician engagement in safety and quality reporting in a large academic health system

Abstract

Background: Incident reporting systems (IRS) can improve care quality and patient safety, yet their impact is limited by clinician engagement. Our objective was to assess barriers to reporting in a hospital-wide IRS and use data to inform ongoing improvement of a specialty-specific IRS embedded in the electronic health record targeting anaesthesiologists.

Methods: This quality improvement (QI) evaluation used mixed methods, including qualitative interviews, faculty surveys and user data from the specialty-specific IRS. We conducted 24 semi-structured interviews from January to May 2023 in a large academic health system in Northern California. Participants included adult and paediatric anaesthesiologists, operating room nurses, surgeons and QI operators, recruited through convenience and snowball sampling. We identified key themes and factors influencing engagement, which were classified using the Systems Engineering Initiative for Patient Safety framework. We surveyed hospital anaesthesiologists in January and May 2023, and characterised the quantity and type of reports submitted to the new system.

Results: Participants shared organisation and technology-related barriers to engagement in traditional system-wide IRSs, many of which the specialty-specific IRS addressed-specifically those related to technological access to the system. Barriers related to building psychological safety for those who report remain. Survey results showed that most barriers to reporting improved following the specialty-specific IRS launch, but limited time remained an ongoing barrier (25 respondents out of 44, 56.8%). A total of 964 reports with quality/safety concerns were submitted over the first 8 months of implementation; 47-76 unique anaesthesiologists engaged per month. The top safety quality categories of concern were equipment and technology (25.9%), clinical complications (25.3%) and communication and scheduling (19.9%).

Conclusions: These findings suggest that a specialty-specific IRS can facilitate increased physician engagement in quality and safety reporting and complement existing system-wide IRSs.

Keywords: Electronic Health Records; Health services research; Quality improvement.

Figure 1. Workflow for all IRSs. Depending on the category selected the reporter could be prompted to submit a report to the hospital-wide IRS instead. EHR, electronic health record; IRS, incident reporting systems; QI, quality improvement.

Figure 2. Engagement with the specialty-specific incident reporting system from October 2022 through May 2023. (A) Shows the number of quality and safety reports and number of unique physician reporters per month. (B) Shows the percentage (%) of quality and safety concern types out of the total number of quality and safety concerns for each month.