the analysis of incidents is one way of increasing safety in workplaces. in this approach, the process of preparing exact and scientific report is a critical step. the aim of this paper was to describe an intervention supporting the improvement of supervisors’ participation to report all occurred incidents. in this study, future workshop method was used with 44 supervisors in tab steel company,...

In 1999 the United States’ Institute of Medicine (IOM) issued a report entitled ‘To Err is Human: Building a Safer Health System’ which estimated that between 44,000 and 98,000 patients die each year in US hospitals as a result of preventable medical errors. According to the report, deaths from preventable medical errors are more common than deaths due to car crashes, AIDS and breast canc...

PURPOSE The main goal of the current research was to investigate whether and how leaders in health care organizations can stimulate incident reporting and error management by "walking the safety talk" (enacted priority of safety). DESIGN/METHODOLOGY/APPROACH Open interviews (N = 26) and a cross-sectional questionnaire (N = 183) were conducted at the Rotterdam Eye Hospital (REH) in The Netherl...

OBJECTIVES To assess awareness and use of the current incident reporting system and to identify factors inhibiting reporting of incidents in hospitals. DESIGN, SETTING AND PARTICIPANTS Anonymous survey of 186 doctors and 587 nurses from diverse clinical settings in six South Australian hospitals (response rate = 70.7% and 73.6%, respectively). MAIN OUTCOME MEASURES Knowledge and use of the ...

Incident reporting lies at the heart of many initiatives to improve patient safety. The UK National Patient Safety Agency (NPSA)1 has recently launched a national reporting and learning system following substantial piloting and testing across the National Health Service (NHS). In the USA the Agency for Healthcare Research and Quality (AHRQ) made incident reporting the centrepiece of its first p...

OBJECTIVE To evaluate the performance of a routine incident reporting system in identifying patient safety incidents. DESIGN Two stage retrospective review of patients' case notes and analysis of data submitted to the routine incident reporting system on the same patients. SETTING A large NHS hospital in England. POPULATION 1006 hospital admissions between January and May 2004: surgery (n...

Incident reporting is a very well-known technique in application domains such as air traffic management and health, where specialized users are trained to provide detailed information about problems. Incident reporting systems are indeed complex systems that include many actors including the users reporting incidents, user’s colleagues and neighbors, stakeholders, policymakers, systems integrat...

OBJECTIVE To examine: (1) the reliability of the severity rating scale used by the National Reporting and Learning System (NRLS) in England and Wales for medication errors; and (2) the likelihood of reporting medication errors among healthcare professionals. SETTING A 900-bed acute university teaching hospital in the North West of England. PARTICIPANTS Forty healthcare professionals (10 doc...

BACKGROUND Delays in reporting of medical errors may signal deficiencies in the performance of hospital-based incident reporting. We sought to understand the characteristics of hospitals, providers and patient injuries that affect such delays. SETTING AND METHODS All incident reports filed between May 2004 and August 2005 at the Kyoto University Hospital (KUH) in Japan and the Brigham and Wom...