Table 2 Organizational problems inhibiting the reporting of clinical errors by the healthcare team from the perspective of nurses

Organizational problems

Motivational

problems related to reporting clinical errors in a system

Failure to obtain expected results

1. Staff members do not obtain the expected outcomes from reporting clinical errors.

2. Inspiring people who have no direct connection with the recording and reporting of clinical errors.

3. Failure to take corrective measures taken after reporting clinical errors

4. Failure to provide financial incentives for reporting clinical errors

5. Concessions should be proportional to the type of clinical error reported

Suspicion of colleagues and all members of the healthcare team

1. The individual committing an error is ostracized by colleagues

2. The individual committing an error feels that other colleagues attribute the clinical error to his/her negligence

Censure by nurse supervisor

1. The individual committing an error is severely criticized by ward supervisor.

2. Not being cooperative with the individual committing an error (e.g., rejecting leave requests)

3. Though the error might be minimal, it will have long-term consequences and repercussions.

Fear of physicians’ managerial

role or positions

1. Clinical errors committed by physicians affiliated with university or members of the board of directors of the hospital are not reported.

2. Failure to report a clinical error due to a physician’s negligence

3. Fear of censure by the attending physician once the clinical error is reported.

The procedural problems of the system

Workload of the medical staff

1. Lack of sufficient time to record and report errors due to the shortage of ward staff

2. An increase in patients seeking treatment at university hospitals especially after the Health Reform Act and the unproportionate ratio of patients to health care staff even after more than three rounds of nursing and medical care staff employment.

3. Failure to have a skilled staff member in patient

Problems with reporting clinical errors

1. Current forms for the recording of clinical errors are extensive and complicated

2. The majority of the medical staff are unaware of the procedure for reporting clinical errors

3. Unavailability of clinical error report forms during all hospital shifts.

4. The faulty and lengthy process of recording the clinical error through clinical error databases

Structural problems

Absence of an HSE manager at the hospital

1. An HSE officer in addition to a supervisor should be assigned to each shift.

Absence of a psychologist in high-risk wards

1. Failure to hire a trained psychologist in high-risk wards who is responsible to predict possible clinical errors in the ward and to mentally prepare the staff for dealing with potential clinical errors.

Managerial problems

Indifference of top management towards dealing with clinical errors

1. Failure to control the procedure and method of reporting of clinical errors in the ward by ward supervisors and directors of shifts.

2. Failure to create an HSE culture

3. The shortage in ward staff brings on heavy workload in university hospitals, making administrative staff set lower expectations from the health care staff to focus on the patients well-being in lieu of reporting and following up clinical errors. By the same token, the personnel fail to pay due attention to the aforementioned issues.

4. Lack of transparency in the use of recorded clinical errors (especially when used for the improving of quality of service)

5. Administrative staff may exert subjective discretion when a clinical error occurs.