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Factors influencing the reporting of patient safety incidents that result from health information technology (HIT) failure are poorly understood. We examined whether organizational justice is associated with the non-reporting of HIT system-related safety incidents among registered nurses. Cross-sectional survey data were collected from nurses (N = 1399) who reported encountering a HIT system-related patient safety incident within the past 12 months. Selecting one or more reasons for not filing an incident report from a predefined list of potential reasons was used as an indicator for non-reporting. Logistic regression models were fit to predict the reason-specific likelihood of non-reporting with organizational justice. High organizational justice was associated with a reduced likelihood of non-reporting if non-reporting occurred because reporting was too hard or took too much time (OR = 0.81, 95% CI 0.67 to 0.96), because the reporting had no impact on the organization’s processes (OR = 0.63, 95% CI 0.53 to 0.76), because the respondent was worried about the consequences (OR = 0.61, 95% CI 0.43 to 0.87), or because the respondent was not required to file a report (OR = 0.67, 95% CI 0.51 to 0.89). Justice was not associated with non-reporting if it occurred due to the lack of access to a reporting system, because no actual harm was caused to the patient, or some other, non-specified reason. The associations were robust to adjustment for several nurse and work characteristics. The results suggest that non-reporting of HIT system-related safety incidents is less common in a high-justice work environment. Fair treatment of nurses may encourage their reporting of safety incidents.

Incident-reporting schemes can prevent accidents through organizational learning from incidents. However, many occupational health and safety incidents go unreported. For these reasons I undertook ethnographic fieldwork to investigate the low level of reporting among railway maintenance technicians in Sweden and the role played by informal storytelling within their occupational communities. The study found that the incident-reporting scheme is not integrated in technicians' practices and cultural frame and does not seem to serve their interests. Storytelling, however, is an integral part of technicians' practices and their accident etiology and creates a way for them to address risks, at least from a narrow perspective. The occupational etiology is based upon technicians' local practice, which emphasizes vigilance, carefulness, skill, responsibility, and the like, and usually neglects root causes. This frame is rational and intelligible, given the technicians' limited power to influence their working conditions, as well as their limited training and the poor feedback they receive when incidents are reported. However, the occupationally-based perspective impedes the articulation of a systems perspective that could be used for organizational learning. To make an incident-reporting scheme work, employees must be given ownership, must know how and why to use it, and need feedback on root causes. These root causes must also be addressed. © 2007 Elsevier Ltd. All rights reserved.