ArticleBMJ quality & safety2015
Fix and forget or fix and report: a qualitative study of tensions at the front line of incident reporting.
Article in BMJ quality & safety, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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Who cites it
25 citing papers in PubMed.
- Learning in radiation oncology: 12-month experience with a new incident learning system.Journal of medical radiation sciences · 2025Article
- Challenges and dynamics in reporting medical device incidents: a qualitative study.Frontiers in health services · 2025Article
- Leveraging LLM to identify missed information in patient-physician communication: improving healthcare service quality.Frontiers in medicine · 2025Article
- Improvement proposals and actions in medication error reports: Quality and strength: A cross-sectional study.Health science reports · 2024Article
- Analysis of Intervention Employability in Pharmacy-Related Medication Safety Reports at a Tertiary Medical Center.Hospital pharmacy · 2024Article
- Clinical Informatics Team Members' Perspectives on Health Information Technology Safety After Experiential Learning and Safety Process Development: Qualitative Descriptive Study.JMIR formative research · 2024Article
- A Machine Learning Approach with Human-AI Collaboration for Automated Classification of Patient Safety Event Reports: Algorithm Development and Validation Study.JMIR human factors · 2024Article
- Analysis of health care professionals' incident reports on medical devices in Croatia.Croatian medical journal · 2023Article
- Risk management patterns in radiation oncology-results of a national survey within the framework of the Patient Safety in German Radiation Oncology (PaSaGeRO) project.Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2023Article
- Improving Safety Performance of Construction Workers through Learning from Incidents.International journal of environmental research and public health · 2023Article
- Electronic On-line Incident Reporting System (IRS) as a Tool for Risk Assessment in Radiation Therapy.Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH · 2023Article
- Utilization of ChatGPT in Medical Education: Applications and Implications for Curriculum Enhancement.Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH · 2023Article
- Managing ongoing swallow safety through information-sharing: An ethnography of speech and language therapists and nurses at work on stroke units.International journal of language & communication disorders · 2022Article
- How do healthcare practitioners use incident data to improve patient safety in Japan? A qualitative study.BMC health services research · 2022Article
- Article
- Medication incident recovery and prevention utilising an Australian community pharmacy incident reporting system: the QUMwatch study.European journal of clinical pharmacology · 2021Observational
- The effect of patient safety culture on nurses' near-miss reporting intention: the moderating role of perceived severity of near misses.Journal of research in nursing : JRN · 2021Article
- Incident Reporting in Perfusion: Current Perceptions on PIRS-2.The journal of extra-corporeal technology · 2020Article
- Learning from Workers' Near-miss Reports to Improve Organizational Management.Mining, metallurgy & exploration · 2020Article
- The role of risk avoidance and locus of control in workers' near miss experiences: Implications for improving safety management systems.Journal of loss prevention in the process industries · 2019Article
Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionPractitioners frequently encounter safety problems that they themselves can resolve on the spot. We ask: when faced with such a problem, do practitioners fix it in the moment and forget about it, or do they fix it in the moment and report it? We consider factors underlying these two approaches.
methodsWe used a qualitative case study design employing in-depth interviews with 40 healthcare practitioners in a tertiary care hospital in Ontario, Canada. We conducted a thematic analysis, and compared the findings with the literature.
results'Fixing and forgetting' was the main choice that most practitioners made in situations where they faced problems that they themselves could resolve. These situations included (A) handling near misses, which were seen as unworthy of reporting since they did not result in actual harm to the patient, (B) prioritising solving individual patients' safety problems, which were viewed as unique or one-time events and (C) encountering re-occurring safety problems, which were framed as inevitable, routine events. In only a few instances was 'fixing and reporting' mentioned as a way that the providers dealt with problems that they could resolve.
conclusionsWe found that generally healthcare providers do not prioritise reporting if a safety problem is fixed. We argue that fixing and forgetting patient safety problems encountered may not serve patient safety as well as fixing and reporting. The latter approach aligns with recent calls for patient safety to be more preventive. We consider implications for practice.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.