Under-reporting of patient safety incidents in Indonesian hospitals: a mixed-methods study

Submission note: A thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Victoria, Australia.

The patient safety incident reporting system was implemented in Indonesia in 2005 and has operated since then. Despite the comprehensive system of reporting and policies, the number of incidents reported to the National Committee on Hospital Patient Safety each year has remained low. The purpose of this study is to analyse the factors contributing to under-reporting of patient safety incidents in Indonesian hospitals by exploring the perspectives of government organisations and other organisations involved in the implementation of incident reporting. This study employed a mixed-methods approach and adopted a convergent parallel design that covered central, provincial and district or city levels. The quantitative phase measured the knowledge, attitudes, cultural and practical barriers to reporting, and the practice of reporting involved 1,121 health workers from three public hospitals: in addition, 33 participants from 16 organisations were involved in qualitative phase. The statistical findings show that profession, work unit and attendance at quality and safety training each had a significant association with the practice of reporting, as well as some factors within knowledge, attitude, practical and cultural barriers to report. The causes of the under-reporting were found within the government and leadership, the relationship with external organisations, hospital organisational and management factors, individual factors and the incident reporting system. This study is the first mixed-methods study focused on the under-reporting of patient safety incidents in Indonesia also the first to consider Javanese values as cultural barriers to reporting incidents. The study limitation included the hospital sampling were non-randomly selected and the selection of interview participants may be biased as other potential participants may have had more knowledge about the issues. Recommendation given were by improving the role of government, the performance of organisations contributed to patient safety implementation and put the patient safety as priority in hospital or national level.