Policy implementers' perspectives of the implementation of the national guidelines for patient safety incident reporting in selected South African public hospitals.

backgroundThe voices of implementers are crucial in enhancing policy implementation. In the North West Province of South Africa, there have been no studies on the implementation of national guidelines for patient safety incident reporting since its introduction. Hence, this study explored the implementation of the national guidelines for patient safety incident reporting in selected public hospitals in the Dr Kenneth Kaunda district from the implementers' perspectives.

methodThis study employed a qualitative exploratory design with purposive sampling of hospital leaders, nurses, doctors, physiotherapists, occupational therapists, and pharmacists, leading to a total of 23 focus group discussions, spread across three participating hospitals, with four to seven participants in each focus group. The policy triangle framework of context, content, actors, and process guided the development of the focus group discussion guide and informed a deductive thematic analysis.

resultsSeven themes emerged, including contextual issues leading to implementing guidelines, common incidents & contributing factors, clarity of policy content, actors' knowledge, role clarity, motivation, and implementation process. The context of implementing guidelines was a need to standardise reporting practices, improve record-keeping, and mitigate potential litigation risks. Key contributing factors to patient safety incidents were inadequate security response, staff shortages, and resource constraints. The content of standard operating procedures was clear, yet lengthy. Discrepancies between the reporting tool and standard operating procedures complicated the reporting process. The actors' knowledge gaps hindered accurate reporting. Managers lacked effective strategies for motivating their reporting staff, further impeding the system's efficacy. While intrinsic motivation, grounded in professional accountability, drove some reporting, fears of consequences were present. The process of reporting was considered burdensome, and insufficient feedback mechanisms left staff uncertain about the value of their contributions.

conclusionTo improve implementation of the patient safety incident reporting, a system-wide approach is necessary; healthcare providers and leaders' knowledge must be improved, strategies to motivate reporting must be explored, leaders must create environments conducive for reporting, including protection of the reporters, and improvements after every reported system-level weakness are mandatory in order to encourage reporting. If reporting is for learning, anonymous reporting should be emphasised. Reporting processes must be made easy and consider available technology.