Understanding the factors influencing doctors' intentions to report patient safety concerns: a qualitative study

Objectives To investigate doctors' intentions to raise a patient safety concern by applying the socio-psychological model 'Theory of Planned Behaviour'. Design Qualitative semi-structured focus groups and interviews. Setting Training venues across England (North West, South East and South West). Participants Sampling was purposeful to include doctors from differing backgrounds and grades. Main outcome measures Perceptions of raising a patient safety concern. Results While raising a concern was considered an appropriate professional behaviour, there were multiple barriers to raising a concern, which could be explained by the Theory of Planned Behaviour. Negative attitudes operated due to a fear of the consequences, such as becoming professionally isolated. Disapproval for raising a concern was encountered at an interpersonal and organisational level. Organisational constraints of workload and culture significantly undermined the raising of a concern. Responses about concerns were often side-lined or not taken seriously, leading to demotivation to report. This was reinforced by high-profile cases in the media and the negative treatment of whistle-blowers. While regulator guidance acted as an enabler to justify raising a concern, doctors felt disempowered to raise a concern about people in positions of greater power, and ceased to report concerns due to a perceived lack of action about concerns raised previously. Conclusions Intentions to raise a concern were complex and highly contextual. The Theory of Planned Behaviour is a useful model to aid understanding of the factors which influence the decision to raise a concern. Results point to implications for policymakers, including the need to publicise positive stories of whistle-blowers and providing greater support to doctors.