Barriers to Reporting Medical Errors: A Qualitative Study in Iran

Document Type : Original Article


1 Department of Anesthesia and Intensive Care, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

2 Eye Research Center, Farabi Eye Hospital. Tehran University of Medical Sciences, Tehran, Iran.

3 School of Nursing & Midwifery, Islamic Azad University of Ghachsaran, Ghachsaran, Iran.


This study aimed to emphasize the challenges in the error reporting system as one of the professionalism codes in clinical settings in hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran.
Materials and Methods:
In total, 23 focused group discussion sessions were conducted with 85 faculty members, assistants, and interns, as well as 165 staff members in 2016. The participants were selected using a purposeful sampling method. Furthermore, the views of four faculty members were gathered again via emails in 2020 to ensure data accuracy. The extracted codes were managed using conventional content analysis through MAXQDA software.
Analysis of participants' discussions led to the identification of 105 codes, which were classified into six sub-categories and two main categories, including "barriers to reporting errors of peers " and "barriers to self-reporting errors".
Most of the non-reporting errors are due to participant’s concerns. Such concerns are generally the result of poor system management or are merely misunderstandings; accordingly, errors' addressing only requires gaining a person's trust. The seriousness of the system in persuading people to report errors is one of the most important ways to gain a person's trust.


  1. Goold SD. Money and trust: relationships between patients, physicians, and health plans. Journal of Health Politics, Policy and Law. 1998; 23(4):687-95.
  2. Hilton S, Southgate L. Professionalism in medical education. Teaching and Teacher Education. 2007;23(3):265-79.
  3. Cruess SR. Professionalism and medicine's social contract with society. Clinical Orthopaedics and Related Research. 2006;449:170-6.
  4. Cant R. Constructions of competence within dietetics: trust, professionalism and communications with individual clients. Nutrition & Dietetics. 2009;66(2):113-8.
  5. Cruess SR, Cruess RL. Professionalism and medicine's social contract with society. AMA Journal of Ethics. 2004;6(4):185-8.
  6. Buchanan AE. Trust in managed care organizations. Kennedy Institute of Ethics Journal. 2000;10(3):189-212.
  7. Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. Cmaj. 2004;170(11):1678-86.
  8. Tehrani SS, Nayeri F, Parsapoor A, Jafarian A, Labaf A, Mirzazadeh A, et al. Development of the first guideline for professional conduct in medical practice in Iran. Archives of Iranian medicine. 2017;20(1):12-15.
  9. Donaldson MS, Corrigan JM, Kohn LT. To err is human: building a safer health system.  Washington: DC; 2000.
  10. Lawton R, Parker D. Barriers to incident reporting in a healthcare system. BMJ Quality & Safety. 2002;11(1):15-8.
  11. Manjooghi N, Noori A, Arizi H, Fasihizade N. The error reported by the nurses of the hospital. Iranian Journal of Medical Ethics and History. 2012; 5(4):51-65.
  12. Kouhestani H, Baghcheghi N. Refusal in reporting medication errors from the viewpoints of nursing students in Arak University of Medical Sciences. Iranian Journal of Medical Education. 2008; 8(2):1-8.
  13. Movahednia S, Partovishayan Z, Bastanitehrani M, Moradi F. Nurse Managers' perspectives about Reasons for not reporting medical errors in Firoozgar Hospital: 2012. Razi Journal of Medical Sciences. 2014;21(125):110-8.
  14. Laal F, Fazli B, Balarak D, Dalir F, Mohammadi M, Mirzaei R. Attitude toward the Patient Safety Culture in healthcare systems. Journal of Patient Safety & Quality Improvement. 2016;4(2):363-8.
  15. Zahmatkeshan N, Bagherzadeh R, Mirzaei K. Evaluate the types and causes of medication errors made by nurses working in selected hospitals in Bushehr province. South medication journal. 2007;13(3):201-06.
  16. Hashemi F, Nasrabadi AN, Asghari F. Factors associated with reporting nursing errors in Iran: a qualitative study. BMC nursing. 2012;11(1):1-8.
  17. Nasiripour A, Raeissi P, Jafari M. The role of disclosure and reporting in medical errors prevention. Journal of Safety Promotion and Injury Prevention. 2014;2(2) :73-84.
  18. Mansbach A, Kushnir T, Ziedenberg H, Bachner YG. Reporting misconduct of a coworker to protect a patient: a comparison between experienced nurses and nursing students. The scientific world journal. 2014; pp. 1-6.
  19. Hoover DL. Exploring military physician perceptions of medical error: Capella University;. ProQuest Dissertations Publishing,2008.
  20. Ghasemi F, Valizadeh F, MomenNasab M. Study on nurses perceptions of medication errors in Khorramabad hospitals. Yafteh.2005;10(2):55-63.
  21. Salavati S, Hatamvand F, Tabesh H. Nurses’ Perspectives on Causes of Medication Errors and Non-Reporting at ED. Iran journal of nursing. 2012; 25(79):72-83.
  22. Patton MQ. Qualitative research and evaluation methods. Thousand Oaks. Cal: Sage Publications,2002.
  23. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qualitative health research. 2005;15(9):1277-88.
  24. Zhang Y, Wildemuth BM. Qualitative Analysis of Content. Applications of Social Research Methods to Questions in Information and Library Science. Bogotá, 2016.
  25. Lincoln YS, Guba EG. Establishing trustworthiness. Naturalistic inquiry. 1985; 289: 331.
  26. Anoosheh M, Ahmadi F, Faghihzadeh S, Vaismoradi M. Causes and management of nursing practice errors: a questionnaire survey of hospital nurses in Iran. International nursing review. 2008;55(3):288-95.