Why is learning from patient safety incidents (still) so hard? A sociocultural perspective on learning from incidents in healthcare organizations.
Rowland P, Lan MF, Wan C, et al. Why is learning from patient safety incidents (still) so hard? A sociocultural perspective on learning from incidents in healthcare organizations. J Health Organ Manag. 2025;Epub Jan 15. doi:10.1108/jhom-08-2024-0334.
Patient safety event reports and investigations offer unique opportunities for individual and organizational learning. In this study, researchers interviewed staff and physicians at one Canadian hospital about their experiences with incident investigations and follow-up processes. Participants noted that issues such as privacy policies and a focus on severe outcomes can hamper learning opportunities.