Vol. 5, No. 11, November 2024
E-ISSN: 2723 - 6692
P-ISSN: 2723 - 6595
http://jiss.publikasiindonesia.id/
Journal of Indonesian Social Sciences, Vol. 5, No. 11, Novebember 2024 3087
Impact of Patient Safety Culture and Reporting Flow
Lovi Krissadi, Supriyantoro
Universitas Esa Unggul , Jakarta, Indonesia
Email: krissadilovi@gmail.com, pri118@yahoo.com
Correspondence: krissadilovi@gmail.com*
KEYWORDS
ABSTRACT
Patient Safety Incident;
underreporting; Patient Safety
Culture; Perception; Nurses
The nursing unit accounts for the highest number of Patient Safety
Incidents (PSI), with 64.83% of incidents in Hospital X Malang
occurring in this unit, creating opportunities for underreporting.
This study analyzes the influence of patient safety culture on nurses'
willingness to report incidents, using a descriptive quantitative
cross-sectional approach with Partial Least Square analysis. Data
were collected through questionnaires from nurses in various units.
Results showed a moderate safety culture and reporting willingness,
with significant effects of safety culture on perceptions of reporting
flow, which in turn influenced reporting willingness. Weaknesses
were found in understanding report-making and grading
implementation. The study emphasizes the need to foster a strong
patient safety culture and streamline reporting systems. Practical
applications include targeted training for nurses, enhanced
communication channels, and a non-punitive reporting framework
to reduce underreporting, strengthen reporting systems, and
improve patient safety.
Attribution-ShareAlike 4.0 International (CC BY-SA 4.0)
Introduction
In the past, the first reaction to a patient safety incident (PSI), hereafter referred to as an
incident in the hospital, was often to blame the staff involved, and punitive measures were taken. This
resulted in staff being reluctant to report incidents. According to Noble and Provonost (2010) Patient
Safety Incidents that are not reported or hidden will contribute to the inability of health services to
accurately identify patient safety risks. There are several factors that cause health workers to be
reluctant to report Patient Safety Incidents, including fear of punishment (being fired from work),
fear of lawsuits, unclear reporting systems, complex administration and documentation and unclear
follow-up of reported incidents. (Noble, Pronovost, & Fccm, 2010)
There are problems that often hinder incident reporting, namely reports are perceived as
nurses' work, including reports that are often hidden / underreported. Data from the US shows that
only about 4-50% of actual incidents are reported, while data from the United Kingdom shows that
at least 22-39% of medical errors are not reported. The underreporting of Patient Safety Incidents
causes the Patient Safety Incident data to be biased.
The Hospital Patient Safety Committee (KPPRS) has made guidelines for Patient Safety Incident
reporting in 2015, there are 13 points of incident reporting flow to the hospital patient safety team
(internal) which are translated by the hospital into Patient Safety Incident Reporting. (KKP- RS,
e-ISSN: 2723-6692 p-ISSN: 2723-6595
Journal of Indonesian Social Sciences, Vol. 5, No. 11, Novebember 2025 3088
2008). The Patient Safety Incident Report in 2018 was divided into two semesters, namely semester
I and II. During Semester I, 9 incidents were reported while Semester II increased to 45 incidents as
illustrated in the following graph.
Figure 1. IKP report at X Malang Hospital
Based on the 2018 IKP Data Report at X Malang Hospital, 64.83% occurred in the nursing unit,
18.5% in the pharmacy unit, and 49.25% by doctors, and 7.40% in other units. The high number of
Patient Safety Incidents in the nursing unit is in accordance with the distribution of Patient Safety
Incident Reports published by KKPRS in 2015, where the nursing unit contributed the highest number
of incidents. (Djoti, 2019). The highest percentage increase occurred in the inpatient room with a
percentage increase in IKP cases of 30% when compared to the same month in 2016. (Handayani &
Kusumapradja, 2018).
Based on the data above that the nursing unit, especially inpatients, contributes to a fairly high
IKP reporting rate, the researcher wants to examine nursing staff because they are directly related to
patients and the largest number of nurses in the hospital as the object of research, who work in
inpatient units, Intensive Care Units, Operating Room Units, Emergency Units and outpatient units.
Meanwhile, to find out the culture, it is necessary to measure the culture of patient safety in the
hospital. The measurement survey used the HSPSC (Hospital Survey on Patient Safety Culture) survey
formulated by AHRQ (American Hospital Research and Quality) in 2007. HSPSC is an instrument
designed to measure hospital staff opinions on patient safety issues, medical errors and incident
reporting. The survey consists of 42 items divided into sections, namely; 18 questions about the unit,
4 questions about the unit manager, 6 questions about communication within the unit, 3 questions
about the frequency of incident reporting within the unit and 11 questions about the hospital
(Authors, 2013). The 42 items reflect a patient safety culture categorized into 12 dimensions. These
dimensions are cooperation within the unit, expectations and actions of managers in promoting
patient safety, organizational learning with continuous improvement, management support for
patient safety, perception of patient safety, communication and reciprocity about errors, openness of
communication, frequency of incident reporting, cooperation between units, staffing, information
passing and patient transfer, non-punitive reaction to errors.
The results of the patient safety culture survey at X Malang Hospital in 2018 using HSPSC with
most respondents being nurses (53%). The survey results showed a strong culture in the dimensions
of continuous improvement, feedback and communication on errors and cooperation within the unit,
weak culture in the dimensions of expectations and actions of managers in promoting patient safety,
non-punitive response to errors, and staffing.
Given the weak patient safety culture, and the increase in Patient Safety Incidents in 2018 is a
phenomenon. If the increase in incidents is real data, then on the one hand it shows a good reporting
system, but on the other hand it shows that the quality of service quality is not good, one of which can
e-ISSN: 2723-6692 p-ISSN: 2723-6595
Journal of Indonesian Social Sciences, Vol. 5, No. 11, Novebember 2024 3089
be caused by not reporting potential conditions of injury or near injury so that they are not prevented
from becoming incidents. In the poor X Hospital IKP report, unexpected events are higher than
potential injury or near injury conditions. If staff are diligent in reporting potential injury or near
injury conditions, it is expected that there will be no adverse events. However, in poor X Hospital, the
number of KNC is less than KTD, it can be assumed that many reports are not reported / hidden
(underreporting).
A weak patient safety culture can contribute to underreporting or the existence of hidden
incident cases. To determine the presence of hidden incidents, it is necessary to evaluate the
willingness of health workers to report Patient Safety Incidents. Given that one of the factors causing
underreporting is the unclear reporting system, it is also necessary to evaluate the perception of the
reporting flow of Patient Safety Incidents.
The results of research by Douglas J. Noble (2010), state that underreporting is important to
determine the potential incidence of incidents. A system that is too complex and complicated, will
produce inaccurate information, causing the characteristics of the cause of the problem to be biased.
Incident reporting systems require good understanding, bias reduction, and transparency to produce
reliable and measurable progress. If the system used is easy to understand and simple, it is expected
to provide better benefits.
The purpose of this study was to analyze the effect of patient safety culture on nurses' desire to
report Patient Safety Incidents with the perception of Patient Safety Incident reporting flow as an
intervening variable in Hospital X Malang.
The motivation for the study was that the researcher was interested in quality improvement
and patient safety. Hospital X Malang as a type C private hospital with many patients must provide
patient safety-oriented services, but there are obstacles in its implementation. Is it related to culture,
considering that the patient safety culture in X Hospital is still weak, so there is no desire for nurses
to report incidents. Researchers want to find out what factors contribute most to nurses' willingness
to report incidents. Because reported incidents help obtain valid data to find out the details of the
cause of the incident and its prevention. The amount of underreporting, especially near-injury
conditions, also makes the incident defense system not run based on the "Swiss Cheese Model" theory.
Previous studies have explored factors influencing the underreporting of Patient Safety
Incidents (PSIs), there is limited understanding of the interplay between patient safety culture, the
perception of reporting systems, and the subsequent willingness of nurses to report PSIs. This study
uniquely contributes to the literature by examining these relationships within the specific context of
Hospital X Malang, employing a comprehensive framework that incorporates cultural and systemic
perspectives. By focusing on these dimensions, this research aims to provide actionable insights into
improving reporting systems and fostering a robust safety culture, thereby mitigating the risks
associated with underreporting.
The purpose of this study was to determine the intention of nurses in reporting Patient Safety
Incidents (PSI). The benefits of this study are that it can be used as input to hospital management in
determining policies and decisions related to the implementation of patient safety in Malang X
Hospital, developing incident reporting and improving safety culture so as to improve hospital
quality.
Research Methods
This study used a descriptive analysis method with a quantitative cross-sectional approach and
a causality research design. The sampling process employed a purposive sampling technique to
ensure that participants were representative of the target population. Nurses from inpatient,
outpatient, emergency, operating room, and intensive care units at Hospital X Malang who had
worked for more than one year were selected as respondents, resulting in a total sample size of 100
nurses. This criterion was set to ensure the inclusion of participants with sufficient experience and
familiarity with patient safety reporting systems.
e-ISSN: 2723-6692 p-ISSN: 2723-6595
Journal of Indonesian Social Sciences, Vol. 5, No. 11, Novebember 2025 3090
The choice of the Partial Least Square (PLS) analysis model was justified by its suitability for
examining complex relationships among latent variables, particularly when the sample size is
relatively small. PLS is robust in handling non-normal data distributions and provides a predictive
framework ideal for exploring the influence of patient safety culture on perceptions of reporting flow
and nurses' willingness to report incidents. This approach enhances the rigor of the study by enabling
the identification of direct and indirect relationships among variables, contributing to the replicability
of the findings in similar healthcare settings.
Results and Discussion
1.
2.
1.
2.
3.
4.
5.
e-ISSN: 2723-6692 p-ISSN: 2723-6595
Journal of Indonesian Social Sciences, Vol. 5, No. 11, Novebember 2024 3091
6.
7.
8.
9.
10.
11.
12.
3.
1.
2.
3.
4.
5.
6.
7.
8.
4.
1.
2.
3.
e-ISSN: 2723-6692 p-ISSN: 2723-6595
Journal of Indonesian Social Sciences, Vol. 5, No. 11, Novebember 2025 3092
4.
5.
6.
7.
8.
9.
10.
1.
2.
3.
e-ISSN: 2723-6692 p-ISSN: 2723-6595
Journal of Indonesian Social Sciences, Vol. 5, No. 11, Novebember 2024 3093
e-ISSN: 2723-6692 p-ISSN: 2723-6595
Journal of Indonesian Social Sciences, Vol. 5, No. 11, Novebember 2025 3094
e-ISSN: 2723-6692 p-ISSN: 2723-6595
Journal of Indonesian Social Sciences, Vol. 5, No. 11, Novebember 2024 3095
e-ISSN: 2723-6692 p-ISSN: 2723-6595
Journal of Indonesian Social Sciences, Vol. 5, No. 11, Novebember 2025 3096
e-ISSN: 2723-6692 p-ISSN: 2723-6595
Journal of Indonesian Social Sciences, Vol. 5, No. 11, Novebember 2024 3097
e-ISSN: 2723-6692 p-ISSN: 2723-6595
Journal of Indonesian Social Sciences, Vol. 5, No. 11, Novebember 2025 3098
e-ISSN: 2723-6692 p-ISSN: 2723-6595
Journal of Indonesian Social Sciences, Vol. 5, No. 11, Novebember 2024 3099
Conclusion
Patient safety culture has a positive and significant effect on nurses' desire to report Patient
Safety Incidents with the perception of the Patient Safety Incident reporting flow as an intervening
variable at Hospital X Malang. This shows that the patient safety culture must be improved so that the
nurses' desire to report IKP also increases through the perception of the IKP Reporting Flow, so that
a good and systematic reporting system can be followed up to get a solution so as to minimize the risk
and prevent the same incident from recurring.
Patient safety culture has a positive and significant effect on the perception of the Patient Safety
Incident reporting flow at X Malang Hospital. This means that the better the patient safety culture, the
better the nurses' perception of the patient safety incident reporting flow and the contribution of
patient safety culture to nurses' perceptions of the safety incident reporting flow is 14.6% (R square).
Perception of Patient Safety Incident reporting flow has a positive and significant effect on
nurses' desire to report Patient Safety Incidents at X Malang Hospital. This means that the better the
nurse's perception of the patient safety incident reporting flow, the better the nurse's desire to report
patient safety incidents.
Patient safety culture has a positive and insignificant effect on nurses' desire to report Patient
Safety Incidents at X Malang Hospital. This means that the better the patient safety culture, the more
likely the nurses' desire to report patient safety incidents will be good, although it is not significant
and the contribution of patient safety culture to nurses' desire to report patient safety incidents is
31.4% (R Square).
Patient safety
Patient Safety Incidents (PSI) through the perception of reporting flow as an intervening variable at
Hospital X Malang. To enhance patient safety culture and reporting systems, hospitals are advised to
e-ISSN: 2723-6692 p-ISSN: 2723-6595
Journal of Indonesian Social Sciences, Vol. 5, No. 11, Novebember 2025 3100
conduct regular training on the reporting process, foster a supportive work environment that
encourages open and non-punitive communication, simplify reporting systems with user-friendly
technology, provide recognition for staff actively reporting incidents, and strengthen managerial
involvement in supervision and constructive feedback. Future research is recommended to adopt a
longitudinal design to monitor changes in patient safety culture over time, expand the sample to
include various types of hospitals for broader generalization, and integrate qualitative methods such
as in-depth interviews to explore underlying factors influencing reporting behaviors. By
implementing these recommendations and pursuing further studies, hospitals can enhance patient
safety, reduce incident risks, and deliver safer, higher-quality healthcare services.
References
e-ISSN: 2723-6692 p-ISSN: 2723-6595
Journal of Indonesian Social Sciences, Vol. 5, No. 11, Novebember 2024 3101
