The Power of Near-Miss Reporting: Enhancing Healthcare Quality & Safety

In the healthcare field, patient and employee safety is of paramount importance. With human lives at stake, healthcare organizations strive to minimize errors and prevent adverse events.  Focusing on harm incidents is imperative, and an important approach to reducing harm is to create a culture where near-miss reporting is increased. Near misses - events that come close to causing harm but do not result in injuries or damage - offer a unique opportunity for learning and improvement. Reporting near misses is a crucial tool that plays a significant role in keeping patients and employees safe.      

A recent great article details the tremendous work of WellSpan Health (a past Value Capture client) on near-miss reporting.  This article serves as a great opportunity to explore the value of near-miss reporting and how it fosters a culture of safety within organizations. 

Defining Near-Miss Reporting

Near-miss reporting refers to the systematic collection and analysis of events that could have resulted in patient harm but did not. These events, often referred to as "close calls," represent opportunities for healthcare providers to learn from mistakes and problem-solve to prevent similar incidents in the future. Unlike adverse events, a near miss does not cause harm to the patient, but every near miss provides invaluable insights into potential vulnerabilities within the healthcare system. As an example, a patient slip or even a fall that does not cause an injury would constitute a near miss.   

The Power of Learning from Near Misses

Near-miss reporting is a powerful learning tool for organizations. By building the systems and encouraging employees to report such incidents without fear of retribution, companies can gather data on close calls and identify areas where safety measures may be inadequate or need improvement.  Analyzing near misses can help organizations better understand the root causes of potential accidents and take proactive measures to prevent them from becoming actual incidents in the future.  Even when a patient is not actually injured in a fall, there are conditions that can be learned from to prevent not only future falls without injury, but also those that do lead to injury. 

Promoting a Safety-Conscious Culture

When employees are encouraged to report near misses, it demonstrates that their safety and well-being are top priorities for the organization. This encouragement fosters a safety-conscious culture where employees feel empowered to take ownership of their safety and that of their colleagues. As a result, they become more vigilant in identifying and addressing potential hazards, leading to a reduction in incidents over time. 

Overcoming the Fear of Reporting

In many healthcare settings, employees may be hesitant to report near misses due to a fear of blame or retribution. (The same can be true of patients, families and visitors). To overcome this, it is essential for organizations to establish a psychologically safe culture and a non-punitive reporting system that focuses on learning and improvement rather than assigning blame. Creating an anonymous reporting process or implementing a "just culture" approach can encourage employees and patients to share near-miss incidents without fear of negative consequences. 

Preventing Catastrophic Incidents

While near-miss incidents may seem minor, they often share underlying causes with more severe accidents. By promptly and systematically addressing the issues raised by near-miss reports, organizations can prevent potentially catastrophic incidents from occurring in the future. Neglecting to learn from near misses leaves the door open for similar events to escalate into serious accidents with severe consequences for employees, patients, the work environment, and the hospital’s reputation. 

Enhancing Safety in Operations

Near-miss reporting can provide valuable insights into the effectiveness of existing safety guidance built into operations. If multiple near-miss incidents occur in a specific area or task, it may indicate that further training or procedural adjustments are necessary to ensure employees are adequately prepared to handle potential hazards. As a result, organizations can fine-tune their safety measures and improve their overall safety performance. 

Continuous Improvement and Innovation

Near-miss reports can be used for continuous improvement and innovation in safety practices. By responding in real time to learn about the near miss, organizations can identify specific issues that can be contained/resolved, and then the changes can be shared across the organization to multiply the effect of the improvement.  Additionally, the thought processes and skills that are built in solving safety issues can be applied to so many other issues healthcare workers and patients encounter every day, thereby improving overall organizational performance (for example, see this white paper on WellSpan Health’s daily engagement system and safety focus, and this recent Moody’s comment on WellSpan Health’s financial condition).  

Conclusion

Near-miss reporting is a crucial aspect of building a strong safety culture within organizations. It empowers employees, patients and others to actively contribute to safety improvement, prevents accidents before they happen, and fosters a workplace where everyone feels responsible for the well-being of their colleagues. Embracing near-miss reporting as a learning opportunity enables ongoing and proactive enhancement and improvement of safety protocols, training, and procedures. Ultimately, the value of near-miss reporting lies in its ability to protect patients and employees, reduce accidents, and create a safer, more productive working environment for everyone.