Factors associated with near-miss reporting among healthcare professionals in Israeli primary and community care: a cross-sectional study

Near-miss reporting can reveal system vulnerabilities before patient harm occurs, but evidence on reporting behaviour in primary and community care remains limited. This study examined organisational, professional and perceptual factors associated with self-reported near-miss reporting among healthcare professionals in Israel. Cross-sectional, anonymous, web-based survey of physicians, nurses and allied health professionals in primary care clinics and other community-based services in the Dan–Petah Tikva district of Clalit Health Services, Israel, conducted between January and March 2024. Of 205 submitted questionnaires, 186 were analysed. The outcome was self-reported submission of at least one near-miss report during the previous year; whether participants had encountered a near miss was not assessed. Candidate correlates included work setting, managerial position, training on near-miss events, perceived importance of reporting, self-reported improvement following a previous report, perceived lack of feedback as a reason for non-reporting and perceived reporting frequency. A two-step hierarchical binary logistic regression entered structural variables first and perceptual variables second; the final model was internally validated with 1,000 bootstrap resamples. Overall, 45 of 186 participants (24.2%) reported submitting at least one near-miss report during the previous year. In the full model ( n = 180), submission was associated with primary care clinic work (OR 3.69, 95% CI 1.42–9.55), training on near-miss events (OR 4.86, 95% CI 1.69–13.94), self-reported improvement following a previous report (OR 2.30, 95% CI 1.42–3.73), perceived lack of feedback as a reason for non-reporting (OR 2.21, 95% CI 1.42–3.44) and perceived importance of reporting (OR 2.43, 95% CI 1.16–5.11). Managerial position was attenuated after perceptual variables were added (OR 2.20, 95% CI 0.92–5.28). The optimism-corrected AUC was 0.82 and the corrected calibration slope was 0.81. Among community-based healthcare professionals in Israel, near-miss reporting was associated with training, primary care clinic work and perceived importance of reporting, and reporters rated both the improvement that reports produce and the lack of feedback after reports more highly. Because two measures refer to previous reporting and opportunity to report was not measured, these exploratory cross-sectional associations are neither predictors nor underreporting estimates. Training and organisational responsiveness to reports warrant prospective evaluation.