The associated factors of root cause analysis of incident reporting in public primary healthcare in Malaysia

This study evaluated the proportion of incident reporting in public primary healthcare (PHC) that progressed to root cause analysis (RCA), described incident characteristics and identified factors associated with RCA. Highlighting these determinants is important for strengthening patient safety practices within PHC. This cross-sectional study involved 88 PHCs across 12 districts in Perak that submitted incident reports in 2022. A total of 105 PIP 2.0 incident reports were retrieved and reviewed between 1 and 31 May 2023. All available reports were included. Data were analysed using Pearson's chi-square tests, Yates' correction, simple logistic regression, and multiple logistic regression. Ethical approval was obtained from the National Institutes of Health (NIH) Malaysia and the Perak State Health Department. RCA was conducted for 41% of reported incidents. Clinical incidents had significantly higher odds of progressing to RCA (adjusted OR 6.58, 95% CI 2.43-17.81; p < 0.001). Other variables, namely incident location, incident type, family medicine specialist (FMS) availability and patients per day showed no significant associations with RCA. Clinical incidents were the only significant determinant of RCA, with nearly half of reported incidents progressing to RCA. These findings highlight the need to strengthen learning-oriented reporting in PHC, especially for near-miss and non-clinical incidents. Improving clinical risk governance, staff training, and supportive, non-punitive reporting environments may enhance patient safety. Further research should explore organisational and cultural factors that influence RCA implementation.