Radiology department employees are expected to report safety concerns, ensuring that their patients are cared for in the safest environment possible. However, according to a new study published in Radiology, employees don’t always report such issues.
The authors surveyed more than 600 employees of a tertiary care institution’s radiology department, receiving more than 350 completed surveys. Participants were asked to describe their own reporting habits and various human factors that keep them from reporting all safety concerns. Half of all respondents said they always speak up about safety concerns, meaning the other half do not report safety concerns 100 percent of the time.
In addition, 37 percent said they speak up “most of the time,” 10 percent said they speak up “sometimes” and 2 percent said they “rarely” speak up. One percent of respondents never speak up about such issues.
So why don’t employees speak up 100 percent of the time? Looking specifically at answers of respondents who said they do not always speak up, more than 69 percent identified a high reporting threshold as a barrier.
“This was the most common reason among attending staff and nursing, administration, and transport personnel and refers to staff members not reporting an event unless they are absolutely sure that they were correct, realizing only after the fact that they should have said something, or staff members not being sure to whom to report,” wrote Bettina Siewert, MD, with the department of radiology at Beth Israel Deaconess Medical Center in Boston, and colleagues. “Voicing a concern about an uncertain observation may be especially difficult in medicine because of an unspoken societal expectation that the physician or principle health care provider is all-knowing in his or her work area.”
More than 67 percent of respondents who do not always speak up identified the presence of an authority figure as a human factor that keeps employees from reporting safety concerns, making it the second most common answer.
“Hierarchy within the health care team is traditionally established on the basis of level of training and clinical expertise to help guide team members in providing appropriate patient care,” the authors wrote. “In an ideal scenario, authority gradients in medicine are used to minimize medical error. However, authority gradients can compromise patient care when they undermine the willingness of team members to speak up about safety concerns and thereby become a barrier to achieving 100 percent safety reporting.”
Respondents identified other human factors that act as barriers to reporting safety concerns, including a fear of disrespect, a lack of listening and fear of retribution.
“To pursue 100 percent reporting of safety events, efforts to address underreporting will need to include strategies directed toward elimination of those human factor barriers as well as flattening of authority gradients,” Siewert and colleagues concluded.