Practical and Cultural Barriers to Reporting Incidents Among Health Workers in Indonesian Public Hospitals

Figures & data

Table 1 Study Design and Study Variables

Research Phase	Quantitative Phase	Qualitative Phase
Research design	Descriptive	Phenomenology
Data collection method	Survey	Interviews and direct observations
Sampling schemes	Total sampling	Purposive sampling
Participants (in three sampled hospitals)	1481 nurses, doctors, and allied health personnel	27 Staff at the managerial and supervisor levels (including hospital directors or managers, the heads or secretaries of the patient safety team, and the heads of hospital wards)
Research setting	Clinical service or supporting unit services in hospitals: inpatient, outpatient, emergency department, surgical, pharmacy, radiology, laboratory, intensive care, hemodialysis, labor and delivery, and nutrition	Managerial or supervisory level
Study variables	Practical barriers to reporting^Citation11^–^Citation14 Cultural barriers to reporting (based on Javanese values)^Citation15 The practice of reporting	Practical barriers to reporting Cultural barriers to reporting Difficulties in reporting incidents
Type of questions	Closed-ended question	Open-ended question
Data analysis	Frequency distributions Chi-square analysis	NVivo Thematic analysis

Table 2 Group Categories for the Survey Participants

Category	Number (%)
Witnessed an incident but had not reported it (non-reporting group)	325 (28.9)
Witnessed and reported an incident (reporting group)	341 (30.5)
Had not witnessed an incident	455 (40.6)
Total	1121 (100)

Table 3 Demographic Characteristics of the Non-Reporting and Reporting Groups

Demographic Factors	Number (%)		Chi-Square Result
	Non-Reporting Group (n = 325)	Reporting Group (n = 341)
Sex
Male	93 (28.6)	99 (29.0)	χ^2 = 0.014 P = 0.905
Female	232 (71.4)	242 (71.0)
Age (years)
20–29	144 (44.3)	150 (44.0)	χ^2 = 4.942 P = 0.176
30–39	127 (39.1)	114 (33.4)
40–49	40 (12.3)	61 (17.9)
≥50	14 (4.3)	16 (4.7)
Working Experience
<5 years	157 (48.3)	133 (39.0)	χ^2 = 5.933 P = 0.051
5–10 years	76 (23.4)	97 (28.4)
>10 years	92 (28.3)	111 (32.6)
Profession
Doctors and specialists	33 (10.2)	30 (8.8)	χ^2 = 19.512 P < 0.001*
Nurses	194 (59.7)	255 (74.8)
Allied health personnel	98 (30.2)	56 (16.4)
Education
High school	14 (4.3)	11 (3.2)	χ^2 = 2.380 P = 0.666
Diploma	203 (62.5)	228 (66.9)
Bachelor’s degree	84 (25.8)	82 (24)
Master’s degree	17 (5.2)	12 (3.5)
Other	7 (2.2)	8 (2.3)
Work Unit
Clinical service unit	264 (81.5)	312 (91.5)	χ^2 = 14.373 P < 0.001*
Supporting unit	60 (18.5)	29 (8.5)
Missing values	1 (0.3)	0 (0.0)
Quality and Safety Training
Attended training	42 (12.9)	90 (26.4)	χ^2 = 18.999 P < 0.001*
Had not attended	283 (87.1)	251 (73.6)

Note: *Indicated a significant difference between the reporting and non-reporting groups.

Table 4 Practical and Cultural Barriers to Reporting Incidents, Compared Between the Non-Reporting and Reporting Groups

Statement	Number (%)		P (Chi-Square Test)
	Non-Reporting group (n = 325)	Reporting Group (n = 341)
Practical Barriers
Did not know how to report	147 (45.2)	101 (29.6)	<0.001*
Did not know where to report	127 (39.1)	94 (27.6)	0.002
Too busy	134 (41.2)	138 (40.5)	0.842
Lack of feedback	96 (29.5)	177 (51.9)	<0.001*
Did not know whose responsibility it was to report	80 (24.6)	67 (19.6)	0.122
My colleagues would have been unsupportive	37 (11.4)	36 (10.6)	0.733
Concern about my future career	54 (16.6)	67 (19.6)	0.310
Concern about legal problems	77 (23.7)	74 (21.7)	0.540
Cultural Barriers
Respect for senior staff	94 (28.9)	103 (30.2)	0.717
Afraid others would be punished	68 (20.9)	86 (25.2)	0.189
Afraid that I would be punished	58 (17.8)	69 (20.2)	0.433
Felt ashamed in front of my colleagues	41 (12.6)	45 (13.2)	0.823
Did not want conflict	224 (68.9)	190 (55.7)	<0.001*
Do not want to create problems	159 (48.9)	153 (44.9)	0.295
I understood how it felt	53 (16.3)	51 (15)	0.631
Concern about experiencing bad luck if I reported someone	14 (4.3)	13 (3.8)	0.746

Note: *Indicated a significant difference between the reporting and non-reporting group.

Table 5 Summary of Significant Quantitative and Qualitative Findings

	Quantitative Study	Qualitative Study
Participants	Health workers (reporting and non-reporting group)	Supervisory level
Practical barriers	Did not know how to report Lack of feedback	Lack of knowledge Lack of socialization
Cultural barriers	Did not want conflict	Reluctance to report Fear of reporting

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