Hospital ward incidents through the eyes of nurses – A thick description on the appeal and deadlock of incident reporting systems

• Incident reporting systems have difficulties demonstrating value in healthcare. • Ethnography and thick description are employed to describe incident and reporting. • Incident prevention is embedded in the normal work of nurses. • The use of incident reporting systems has not the sole purpose of learning. • It remains ambiguous how and if reporting practices contribute to patient safety. Incident reporting systems (IRSs) are considered a valuable method to improve patient safety in hospitals. Although many barriers to incident reporting have been identified, little attention is paid to the socio-cultural context of hospital care and the use of IRS over time. Based on ethnographic fieldwork on a neurology/neurosurgery ward of a tertiary referral center in the Netherlands, this article presents a thick description on the perception of nurses and physicians toward incidents, their reporting practices and the general utilization of IRS for improving patient safety. Results suggest that nurses demonstrate a form of structural vigilance in achieving safe health outcomes as part of normal work. Consequently, nurses find it difficult to specify what events can be considered a report-worthy event. Analysis of the use of IRS through four perspectives toward culture (integration, differentiation, fragmentation and bounded ambiguity) showed that the IRS took different forms over time, depending on the legitimacy the reported topics received in the social group dynamics between physicians and nurses. For nurses, it remained often unclear if the actions surrounding the IRS and the invented improvements indeed contributed to patient safety. The results indicate that “incidents” as a concept may have little value for the work on hospital wards and illustrate that IRS has no ‘objective’ purpose in its own right, rather is shaped by the social-cultural context its employed in.