title: Developing the 'gripes' tool for junior doctors to report concerns: a pilot study.
abstract: BACKGROUND
  Junior doctors often have concerns about quality and safety but show low levels of engagement with incident reporting systems. We aimed to develop and pilot a web-based reporting tool for junior doctors to proactively report concerns about quality and safety of care, and optimise it for future use.
  
  
  METHODS
  We developed the gripes tool with input from junior doctors and piloted it at a large UK teaching hospital trust. We evaluated the tool through an analysis of concerns reported over a 3-month pilot period, and through interviews with five stakeholders and two focus groups with medical students and junior doctors about their views of the tool.
  
  
  RESULTS
  Junior doctors reported 111 concerns during piloting, including a number of problems previously unknown to the trust. Junior doctors felt the tool was easy to use and encouraged them to report. Barriers to engagement included lack of motivation of junior doctors to report concerns, and fear of repercussions. Ensuring transparency about who would see reported concerns, and providing feedback across whole cohorts of junior doctors about concerns raised and how these had been addressed to improve patient safety at the trust, were seen having the potential to mitigate against these barriers. Sustainability of the tool was seen as requiring a revised model of staffing to share the load for responding to concerns and ongoing efforts to integrate the tool and data with other local systems for gathering intelligence about risks and incidents. Following piloting the trust committed to continuing to operate the gripes tool on an ongoing basis.
  
  
  CONCLUSIONS
  The gripes tool has the potential to enable trusts to proactively monitor and address risks to patient safety, but sustainability is likely to be dependent on organisational commitment to staffing the system and perceptions of added value over the longer term.
authors.affiliation: Department of Clinical Education, University Hospitals of Leicester, Leicester, UK.
authors.forename: S
authors.initials: S
authors.lastname: Carr
authors.affiliation: University Hospitals of Leicester, Leicester, UK.
authors.forename: T
authors.initials: T
authors.lastname: Mukherjee
authors.affiliation: Queen's University Belfast, Belfast, UK.
authors.forename: A
authors.initials: A
authors.lastname: Montgomery
authors.affiliation: University Hospitals of Leicester, Leicester, UK.
authors.forename: M
authors.initials: M
authors.lastname: Durbridge
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: C
authors.initials: C
authors.lastname: Tarrant