title: Measurable improvement in patient safety culture: A departmental experience with incident learning.
abstract: OBJECTIVE
  Rigorous use of departmental incident learning is integral to improving patient safety and quality of care. The goal of this study was to quantify the impact of a high-volume, departmental incident learning system on patient safety culture.
  
  
  METHODS
  A prospective, voluntary, electronic incident learning system was implemented in February 2012 with the intent of tracking near-miss/no-harm incidents. All incident reports were reviewed weekly by a multiprofessional team with regular department-wide feedback. Patient safety culture was measured at baseline with validated patient safety culture survey questions. A repeat survey was conducted after 1 and 2 years of departmental incident learning. Proportional changes were compared by χ(2) or Fisher exact test, where appropriate.
  
  
  RESULTS
  Between 2012 and 2014, a total of 1897 error/near-miss incidents were reported, representing an average of 1 near-miss report per patient treated. Reports were filed by a cross section of staff, with the majority of incidents reported by therapists, dosimetrists, and physicists. Survey response rates at baseline and 1 and 2 years were 78%, 80%, and 80%, respectively. Statistically significant and sustained improvements were noted in several safety metrics, including belief that the department was openly discussing ways to improve safety, the sense that reports were being used for safety improvement, and the sense that changes were being evaluated for effectiveness. None of the surveyed dimensions of patient safety culture worsened. Fewer punitive concerns were noted, with statistically significant decreases in the worry of embarrassment in front of colleagues and fear of getting colleagues in trouble.
  
  
  CONCLUSIONS
  A comprehensive incident learning system can identify many areas for improvement and is associated with significant and sustained improvements in patient safety culture. These data provide valuable guidance as incident learning systems become more widely used in radiation oncology.
authors.affiliation: Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington. Electronic address: kusano@uw.edu.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Kusano
authors.affiliation: Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Nyflot
authors.affiliation: Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Jing
authors.initials: J
authors.lastname: Zeng
authors.affiliation: Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Sponseller
authors.affiliation: Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Ralph
authors.initials: R
authors.lastname: Ermoian
authors.affiliation: Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Loucille
authors.initials: L
authors.lastname: Jordan
authors.affiliation: Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Joshua
authors.initials: J
authors.lastname: Carlson
authors.affiliation: Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Avrey
authors.initials: A
authors.lastname: Novak
authors.affiliation: Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Kane
authors.affiliation: Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Ford
mesh_terms: D005246:Feedback; D006801:Humans; D061214:Patient Safety / Q000706:statistics & numerical data; D011446:Prospective Studies; D011787:Quality of Health Care; D018787:Radiation Oncology / Q000458:organization & administration; D012308:Risk Management / Q000379:methods / Q000458:organization & administration* / Q000706:statistics & numerical data; D017751:Safety Management / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires