Risk perception in the health care domain, between clinical risk and practitioners safety: a study among operating theatres practitioners

Objectives: Risk perception among operating theatres’ practitioners is investigated concerning both the relationship between personal safety and patients’ safety and the perception of causes of accidents.
Methods: A quantitative checklist of Incident Reporting has been used. It consisted in 13 items about clinical risks and 8 items about practitioners’ risks, considering injury frequency and seriousness, its causes and near misses. Participants were 139 and were recruited among physicians, surgeons, anesthetists, nurses of 14 operating theaters of a north Italian wide hospital.
Results: Spearman’s Rho index reveals mild positive correlations between injuries to operators and injures to patients concerning frequency (means = 0,10) and gravity (means = 0,22). The same trend is found for near misses involving operators and patients (r = 0,26); the perception of the frequency and severity of injuries (means = 0,54), and the frequency of accidents and near misses (means = 0,66). We notice also that injuries are positively associated with communication problems and the lack of personal protection devices. The personal and professional characteristics have a positive correlation with accident frequency in case of missed control of devices (correlation with age: r = 0,29; with job experience: r = 0,24). Age and expertise negatively correlate with the frequency of accidents in case of patient injury due to devices failures (r = 0,30 and 0,27 respectively).
Implications: Frequency and seriousness of the practitioners’ and the patients’ risks are positively correlated, and this relationship strengthens when also considering near misses. Communication problems and the absence of devices for personal protection seem to be the most probable causes of accidents, the first if injuries are very frequent, the second if injuries are serious. Professional experience seems to be linked with perceptions of accidents due to behavioural routines, while low surgical skills are correlated with perceptions of accidents due to lack of technical expertise or a scarce sensitivity to dangerous conditions.
Conclusions: These results suggest that the promotion of safety in operating theatres could concern both operators and patients, thanks to an organisational commitment investing in technical matters like personal protection devices to reduce the most frequent accidents (technical approach to safety), but to reducing severe accidents needs making actions at the level of staff management (social approach to safety), also considering age and expertise differences. This tool could be used as a link between organisational practices and the health and safety promotion culture.