QUESTIONNAIRE

TITLE: “CHALLENGES AND BARRIERS IN REPORTING CRITICAL

INCIDENTS: A STUDY IN A TERTIARY CARE TEACHING HOSPITAL”

Dear Sir/Madam,
I am Anuprathap B, a Post Graduate student of Masters in Hospital Administration, at
St. John’s Medical College Bengaluru. I am doing a study on the above title with the prime
objective of; 1. To study the challenges perceived by the staff in reporting critical incidents
2. To study the barriers faced by the management in getting report critical incidents reported
3. To propose measurements to overcome the challenges and barriers in critical incident
reporting by triangulation of findings of the two objectives
This questionnaire is given to you in view of collecting data for this study. All information
collected from you will not be disclosed to any outsider except if it is required by law. There
is no compulsion to agree to this study, you are required to fill out this form only if you
voluntarily agree to participate in this study. The questions will not ask for the participant’s
name and they will ask the demographic data like age, gender, education, and profession. All
the responses received will be kept anonymous. I kindly request you to fill out the form and
submit it to me.

DEMOGRAPHIC:
1. Gender:
2. Age:
3. Qualification:
4. Experience:
5. Designation:
6. Department:
7. Years of experience:

STATEMENTS:

Factor 1: Application of learning from errors

8. Information about incidents is disclosed periodically which helps staff to deliver

healthcare services mindfully.

Strongly Disagree Disagree Neutral Agree Strongly Agree

9. Incidents that need to be reported are clearly defined and recognized in the
 hospital policy.
Strongly Disagree Disagree Neutral Agree Strongly Agree

10. In this unit, the incident report is applied to identify problems with quality

improvements.
Strongly Disagree Disagree Neutral Agree Strongly Agree

11. Knowledge acquired through the incident report is used as in-service training.

Strongly Disagree Disagree Neutral Agree Strongly Agree

12. To staff, their professional competencies are advanced through the incident report

mechanism.
Strongly Disagree Disagree Neutral Agree Strongly Agree

Factor 2: Readiness to provide feedback on incident reports

13. Staff is willing to find out the cause of an incident.

Strongly Disagree Disagree Neutral Agree Strongly Agree

14. The incident reporting system is easy to use.

Strongly Disagree Disagree Neutral Agree Strongly Agree

15. The incident report is well documented for clinical practices.

Strongly Disagree Disagree Neutral Agree Strongly Agree

16. This hospital facilitates system safety and care quality through incident report
mechanisms.

Strongly Disagree Disagree Neutral Agree Strongly Agree

17. Data reported are timely and accurate.

 Strongly Disagree Disagree Neutral Agree Strongly Agree

18. The unit that is involved in incidents will be notified soon after reporting.

Strongly Disagree Disagree Neutral Agree Strongly Agree

Factor 3: Collegial atmospheres of unpleasantness and punishment

19. Reporting incidents could bring about distress in relationships among co-workers.

Strongly Disagree Disagree Neutral Agree Strongly Agree

20. Reporting errors could cause tension and disharmony among departments.

Strongly Disagree Disagree Neutral Agree Strongly Agree

21. Staff who commit errors tend to be blamed.

Strongly Disagree Disagree Neutral Agree Strongly Agree

22. The purpose and implementation of incident reporting systems are not addressed

Strongly Disagree Disagree Neutral Agree Strongly Agree

23. Regardless of making reports, the improvement of the unit or department that incurs
incidents is not effective.

Strongly Disagree Disagree Neutral Agree Strongly Agree

Factor 4: Incident management: confidential and system-driven

24. The identity of the people who made reports is confidential.

Strongly Disagree Disagree Neutral Agree Strongly Agree

25. Reported data are anonymous before open discussion and disclosure.

Strongly Disagree Disagree Neutral Agree Strongly Agree

26. Attitude toward error reporting is ‘system-driven’ not ‘individual-driven’.

Strongly Disagree Disagree Neutral Agree Strongly Agree

27. Staff is comfortable reporting a variety of safety events.

Strongly Disagree Disagree Neutral Agree Strongly Agree

Item Number of Questions Total
Demographic 7 7
Factor 1: Application of 5 5
learning from errors

Factor 2: Readiness to 6 6
provide feedback on incident
reports

Factor 3: Collegial 5 5
atmospheres of
unpleasantness and
punishment

Factor 4: Incident 4 4
management: confidential
and system-driven

Total 27 27
 SEMI-STRUCTURED INTERVIEW

TITLE: “CHALLENGES AND BARRIERS IN REPORTING CRITICAL

INCIDENTS: A STUDY IN A TERTIARY CARE TEACHING HOSPITAL”

Dear Sir/Madam,
I am Anuprathap B, a Post Graduate student of Masters in Hospital Administration, at
St. John’s Medical College Bengaluru. I am studying the above title with the prime objective
of; 1. To study the challenges perceived by the staff in reporting critical incidents
2. To study the barriers faced by the management in getting report critical incidents reported
3. To propose measurements to overcome the challenges and barriers in critical incident
reporting by triangulation of finding the two objectives
This questionnaire is given to you in view of collecting data for this study. All information
collected from you will not be disclosed to any outsider except if it is required by law. There
is no compulsion to agree to this study, you are required to fill out this form only if you
voluntarily agree to participate in this study. The questions will not ask for the participant’s
name and it will ask the demographic data like age, gender, education, and profession. All the
responses received will be kept anonymous. I kindly request you to fill out the form and
submit it to me.

DEMOGRAPHIC:
1. Gender:
2. Age:
3. Qualification
4. Designation:
5. Department:
6. Years of experience:

Factor 1: Application of learning from errors

7. How are critical incidents reported?

8. How often does the Management derive measures and actions based on reported
events?
9. How often is the efficacy of measures and/or actions controlled?
10. How do you check the efficacy of implemented measures?
11. How often are filed CIRS reports processed?
12. How are employees aware of events reported in the CIR system or implemented
measures?
Factor 2: Readiness to provide feedback on incident reports
1. How willing are the staff to report Critical incidents?
2. How easy is the CIR system to use?
3. How The incident report is well documented for clinical practices?
4. How does the hospital facilitate system safety and care quality through incident
report mechanisms?
5. How does the management evaluate the Data reported are timely and accurate?

Factor 3: Collegial atmospheres of unpleasantness and punishment

6. What is the opinion that Reporting errors could cause tension and disharmony

among departments?

7. How the Staff who commit errors are treated?

8. How is the efficiency in addressing the purpose and implementation of incident

reporting systems?

9. How incident reporting is effective in improving the unit or department that incurs

incidents?

Factor 4: Incident management: confidential and system-driven

10. How does the management accomplish to keep the identity of people confidential,

who report the incident?

11. Attitude toward error reporting is ‘system-driven’ not ‘individual-driven’.

12. Staff is comfortable reporting a variety of safety events.

13. Which information about CIRS is generally made available to employees?

14. Which methods of risk analysis and/or assessment are used based on CIRS?

Item Number of Questions Total

Demographic 7 7
Factor 1: Application of 6 6
learning from errors

Factor 2: Readiness to 5 5
provide feedback on incident
reports

Factor 3: Collegial 4 4
atmospheres of
unpleasantness and
punishment

Factor 4: Incident 5 5
management: confidential
and system-driven

Total 27 27