Assessment of Medical Error Reporting Practice and Associated Factors among Obstetrics and Gynecology Residents, Fellows, and Consultants in Teaching Hospitals of Addis Ababa, Ethiopia: A Cross-Sectional Study

Technical Summary: Assessment of Medical Error Reporting Practice and Associated Factors among Obstetrics and Gynecology Residents, Fellows, and Consultants in Teaching Hospitals of Addis Ababa, Ethiopia

1. Problem Statement

Medical errors represent a critical public health challenge globally, contributing significantly to morbidity, mortality, and increased healthcare costs. Despite the existence of national guidelines for reporting safety incidents in Ethiopia, such as the Ethiopian Hospital Reform Implementation Guideline (EHRIG), the actual practice of reporting medical errors remains suboptimal. Previous studies indicate that a vast majority of medical errors go unassessed and unreported, often due to barriers such as fear of legal consequences, punitive measures, lack of training, and systemic weaknesses. In the specific context of obstetrics and gynecology, where the risk of life-threatening conditions for mothers and newborns is high, the lack of transparent error reporting hinders the identification of root causes and the implementation of preventive safety practices. This study addresses the gap in understanding the current state of error reporting practices and the specific factors influencing them among obstetrics and gynecology professionals in Addis Ababa teaching hospitals.

2. Methodology

Study Design and Setting:
The research employed an institution-based cross-sectional study design conducted between February and April 2025. The study was situated in four major teaching hospitals in Addis Ababa: Tikur Anbessa Specialized Hospital (TASH), Yekatit 12 Hospital Medical College (Y12HMC), Ghandi Memorial Hospital (GMH), and Zewuditu Memorial Hospital (ZMH).

Study Population and Sampling:
The target population included all obstetrics and gynecology residents, fellows, and consultants working in these institutions. Residents with less than six months of tenure in their unit were excluded. A census approach was utilized, inviting all eligible members of the target population to participate. The initial sample size calculation, based on a single population proportion formula (assuming a 14.7% reporting rate from previous literature, 5% margin of error, and 95% confidence interval), yielded 193 participants. After accounting for a 10% non-response rate, the target was 212. The final study included 185 participants, resulting in an 87.3% response rate.

Data Collection and Analysis:
Data were collected using a self-administered, structured questionnaire adapted from the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPSC). The tool assessed socio-demographic characteristics and 10 dimensions of patient safety culture. The questionnaire was translated, piloted, and validated, demonstrating a Cronbach's alpha of 0.77. Data were entered into Google Sheets and analyzed using SPSS version 25. Descriptive statistics were used for categorical variables. Bivariate logistic regression identified variables with a p-value < 0.20, which were then entered into a multivariable logistic regression model. An Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) and a p-value < 0.05 were considered statistically significant.

3. Key Results

Demographics:
The study included 185 participants, predominantly male (71.4%) and aged 25–35 years (51.9%). The majority were residents (73%), with 52.4% reporting a weekly workload of 80–99 hours.

Error Reporting Practices:

• Overall Practice: Only 20% of participants demonstrated "good" medical error reporting practices, while 80% exhibited poor practices.
• Frequency: 25.4% of respondents reported no incidents in the past year, and 56.2% reported very few or no incidents.
• Severity Bias: Reporting frequency varied by perceived severity. Errors that could have caused harm but did not were reported most frequently (42.7%), whereas errors caught and corrected before affecting the patient (28.1%) and those with no potential for harm (26.5%) were reported less often.

Patient Safety Culture Dimensions:
Among the 10 assessed dimensions, "Non-punitive response to error" received the highest positive response rate (78.4%), followed by "Teamwork within unit" (63.8%). Conversely, the lowest positive response rates were observed for:

• Frequency of events reported (20%)
• Report rules and content (23.8%)
• Staffing (25.4%)
• Communication openness (31.9%)

Associated Factors (Multivariate Analysis):

• Sex: Female healthcare providers were significantly more likely to report errors than their male counterparts (AOR = 5.2; 95% CI: 2.24–12.09; p < 0.001).
• Teamwork Culture: A positive teamwork culture was significantly associated with a higher likelihood of reporting errors (AOR = 2.7; 95% CI: 1.11–6.76; p = 0.03).
• Professional Position: While consultants were more likely to report errors than residents in the bivariate analysis (COR = 1.9; p = 0.010), this association lost statistical significance in the multivariate model (AOR = 1.8; p = 0.158).

4. Key Contributions

This study provides a quantitative assessment of the gap between perceived safety culture and actual reporting behaviors in a high-risk medical specialty within the Ethiopian context. Its primary contributions include:

• Quantification of Under-reporting: Establishing that only one in five obstetrics and gynecology professionals in Addis Ababa teaching hospitals engages in good error reporting practices.
• Identification of Specific Barriers: Highlighting that despite a high perception of non-punitive responses (78.4%), actual reporting is hindered by low staffing levels, unclear reporting rules, and a lack of feedback mechanisms.
• Demographic Insights: Revealing that gender and teamwork culture are independent predictors of reporting behavior, with female providers and those in supportive team environments being more proactive.
• Selective Reporting Pattern: Documenting a tendency to report only serious or near-miss events while under-reporting minor or corrected errors, which limits organizational learning.

5. Significance of the Study

The authors posit that understanding the specific dynamics of error reporting in obstetrics and gynecology is essential for advancing patient safety. The study's significance lies in its potential to:

• Inform Policy and Training: Provide evidence to develop targeted training materials and support systems for residents, fellows, and consultants to better manage the real-world challenges of error reporting.
• Foster a Safety Culture: Emphasize the need for healthcare organizations to prioritize psychologically safe workplaces, enforce non-punitive responses, and strengthen teamwork to improve reporting rates.
• Generalizability of Principles: While specific to obstetrics and gynecology, the findings regarding systemic barriers (fear of blame, lack of feedback, unclear protocols) are applicable to other medical fields, offering lessons for improving medical practice and patient safety broadly.
• Address Systemic Gaps: Highlight the disconnect between national guidelines (EHRIG) and on-the-ground practice, suggesting that efforts to reduce medical errors must address system-wide processes rather than focusing solely on individual accountability.

The study concludes that improving medical error reporting requires a pragmatic approach that moves beyond individual blame to address systemic deficiencies, including workload management, feedback loops, and the cultivation of a culture where open communication is the norm.