This study explored how psychological safety (PS) affects near-miss reporting and learning in radiation oncology.
They note that near misses contain contrasting cues highlighting both resilience and vulnerability. Based on prior work from Dillon, Tinsley et al., they note that a near miss may have cues of resilience (“we avoided failure”) and vulnerability (“we nearly failed”).
Resilient near misses are processed more like “near successes”, highlighting how success was marginally accomplished.
Conversely, vulnerable near misses highlight how failure was narrowly averted. The previous research highlighted how potential danger can be downgraded or reconceptualised as less concerning by highlighting the “near success” component over the “near failure” component.
Using scenarios, they explored how PS interacted with five scenarios with varying proximity to patient harm (see image 3).
They found that:
· The odds of reporting a “hit”, “almost happened” and “fortuitous catch” improved with an increase in PS
· PS and reporting “standard care” and “could have happened” wasn’t statistically significant
· The odds of reporting were higher when a near miss was discerned as a failure (almost failed, i.e. a vulnerable near miss) rather than a near success (a resilient near miss)
They also showed that near misses aren’t just simply vulnerable or resilient, since different components can be present in the same event. E.g. “This dual-sided nature implies that a near miss could be discerned as success in terms of outcome but also as failure in terms of the problems that transpired right before the outcome”.
They argue that “the role of psychological safety in near-miss reporting is ambiguous, as near misses could be construed as either chance success or chance failure”.
They note that these findings “demonstrate that psychological safety is an important predictor of reporting incidents and select near-miss types. For reporting near misses that closely resemble an incident involving patient harm, the effect of psychological safety was particularly salient”.
For near misses with a close temporal proximity to patient harm, near misses that almost happened were discerned as just as risky as actual events, eliciting “a negative outcome bias and highlight cues of system vulnerability”.
The effects of PS on near misses not in close proximity to patient harm events weren’t statistically significant. Hence, “Near misses with an error that takes place relatively early in the process of care may resemble an ordinary, everyday occurrence more than an incident”.
In sum, PS was found to play a role in determining staff willingness to share about near misses and particularly those with close negative outcomes.
However, improving PS “needs to be coupled with education about near misses. Improving psychological safety may not increase recognition of near misses, particularly those that more closely resemble standard care than an incident”.
Study link: https://www.jointcommissionjournal.com/article/S1553-7250(20)30241-5/pdf
Safety & Performance Research Summaries 
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