Hospital staff will report safety concerns more when they are informed of how their previous reports helped improve patient safety, according to a recent report from St. Jude Children’s Research Hospital in Memphis.

St. Jude researchers analyzed survey data from the federal Agency for Healthcare Research and Quality (AHRQ), from 223,412 healthcare professionals working in 7,816 departments or units at 967 hospitals.

The AHRQ survey asked respondents to indicate the likelihood that staff and physicians would voluntarily report patient safety issues caught before reaching the patient, those with no perceived potential for harm, and those with the perceived potential to cause harm. Previous research suggested that staff were more likely to report errors they perceived as serious, says St. Jude’s Chief Patient Safety Officer James Hoffman, PharmD, an associate member of the St. Jude Department of Pharmaceutical Sciences and co-author of the study.

“The common thought was that healthcare professionals will report what they see as a serious threat to patient safety, but the other, smaller things might be overlooked because people thought they just weren’t worth reporting, or that management wasn’t that concerned about hearing the smaller issues,” Hoffman says.

The St. Jude research suggests, however, that severity doesn’t have to be the prime driver for reporting safety concerns. The study indicates that voluntary reporting of all types of errors and patient safety events, regardless of the perceived severity, will improve if healthcare organizations have robust feedback systems that demonstrate to staff the value of information learned from the events reported, Hoffman says. If staff know their reports make a difference, they will report more.

“People talk about the connection between culture and reporting, and changing culture is a huge project that involves many dimensions in an organization and takes time,” Hoffman says. “But providing feedback is something that you can do every day and it doesn’t necessarily take a huge change initiative.”

The feedback encourages reporting for all levels of harm, Hoffman says. The reporting of near misses improves as much as the reporting of serious events, he says.

The survey focused on 10 factors shown to reflect and influence the culture of patient safety, including providing feedback to staff who report errors, the sense that past mistakes have led to positive changes, perceived management support for patient safety, and the opinion of staff that their mistakes are not held against them. (An abstract of the study is available online at:

“As healthcare becomes more and more transparent, the lessons learned from adverse events and the feedback from reports are expected more,” Hoffman says. “It’s a natural extension that if you’re going to be upfront and honest about patient safety issues, the person who brought that issue to your attention should be kept abreast of what resulted from the report.”

Anonymous reporting of safety concerns, employed by many hospitals through a hotline, will change how feedback is provided but should not be a reason to forgo feedback, Hoffman says. Feedback can be provided globally, to a unit, department, or the organization as a whole rather than to an individual, he says.

Hoffman’s experience with anonymous reporting actually suggests that anonymity is not as big a concern for hospital employees as one might believe. St. Jude has a custom software system for reporting adverse events and safety concerns, but when it was designed hospital leaders decided not to make anonymous reporting the default choice as many organizations do. The user can choose to be anonymous, but the default report asks for the person’s identification.

“We’ve found that to be quite successful. Less than 1% of our reports are anonymous,” Hoffman says. “We see that as a sign of a good safety culture when people are willing to report and don’t mind if everyone knows who made the report. It makes the investigation of the concern much more effective and allows us to go back to that individual and express thanks, along with informing that person exactly what came of the report.”


  • James Hoffman, PharmD, Chief Patient Safety Officer, St. Jude Children’s Research Hospital, Memphis, TN. Telephone: (901) 595-2767. Email: