In behavioral health settings, reporting near misses is a cornerstone of fostering a culture of safety. Near misses—incidents that could have resulted in harm but did not—are crucial learning opportunities that help prevent future adverse events. The Joint Commission (TJC) emphasizes the importance of proactive risk identification and safety improvement in all healthcare settings, including psychiatric hospitals and community behavioral health. However, encouraging staff to report near misses often requires concerted efforts to overcome barriers such as fear of blame, workload concerns, and uncertainty about the reporting process.

Reporting Near Misses in Behavioral Health Settings

By aligning TJC standards and guidelines, behavioral health organizations can create an environment that promotes transparency, continuous learning, and safety. Here are strategies, grounded in TJC resources, to encourage staff to report near misses in behavioral health settings.

1) Foster a Just Culture: Shift from Blame to Learning

TJC stresses the need for healthcare organizations to develop a Just Culture, where staff feel safe to report near misses without fear of retribution. A Just Culture acknowledges that human error is inevitable. It focuses on system improvements rather than individual blame. This culture shift is critical for encouraging staff to report incidents, including near misses, as opportunities for learning and improvement.

TJC Resources:

• TJC’s Sentinel Event Alert #60 outlines strategies for fostering a safety culture, including promoting reporting without fear of punishment.
• The Leadership Standard (LD.03.01.01) requires healthcare organizations to create and sustain a culture of safety, which includes supporting non-punitive reporting systems.

Key Actions:

• Implement policies that explicitly state no punitive action will result from reporting near misses or errors.
• Encourage leadership to lead by example, demonstrating openness to receiving and addressing near miss reports.

2) Create Clear and Accessible Reporting Systems

A complex or time-consuming reporting process can discourage staff from submitting near miss reports. TJC highlights the importance of having clear, accessible systems for incident reporting. This enables staff to report quickly and efficiently without disrupting their workflow.

TJC Resources:

• The Joint Commission’s Performance Improvement (PI) Standards emphasize the importance of data collection and analysis in improving healthcare processes, including the reporting of near misses.
• The Patient Safety Systems (PS) Chapter encourages organizations to establish simple and intuitive reporting systems that enable staff to report adverse events and near misses.

Key Actions:

• Implement user-friendly reporting mechanisms, such as electronic reporting tools integrated into the electronic health record (EHR) system.
• Offer anonymous reporting options to encourage reporting in sensitive situations.

3) Emphasize the Importance and Value of Reporting

The Joint Commission underscores that near miss reporting is vital for continuous improvement. Staff should understand that each report contributes to overall system safety and patient care quality. When staff see the impact of their reports through organizational improvements, they are more likely to participate actively in reporting near misses.

TJC Resources:

• Standard LD.03.09.01 emphasizes the reporting of safety issues , from potential or no-harm errors (close call, near misses, or good catches) to hazardous conditions and sentinel events.

Key Actions:

• Provide feedback to staff on how near miss reports have led to safety improvements or changes in policy.
• Share case studies or examples during team meetings where near miss reports resulted in positive organizational changes.

4) Provide Training on Near Miss Identification and Reporting

Staff may not always recognize what constitutes a near miss or may lack confidence in reporting. TJC encourages ongoing education to ensure that staff are equipped with the knowledge and tools necessary to report near misses and to understand their significance in preventing harm.

TJC Resources:

• The Joint Commission’s Provision of Care (PC) Standards highlight the need for ongoing staff education in recognizing and managing patient risks.

Key Actions:

• Incorporate near miss reporting into new employee orientation and ongoing training programs.
• Use simulation training or real-life scenarios to help staff recognize near misses in behavioral health settings.

5) Establish a Supportive Environment for Behavioral Health Staff

Working in behavioral health can be emotionally demanding, which may affect staff’s ability to focus on reporting near misses. TJC advocates for supporting healthcare workers’ well-being to ensure they are both mentally and physically able to provide safe care. This includes creating an environment where staff feel valued and supported in their roles.

TJC Resources:

• TJC’s Workplace Violence Prevention Standards (EC.02.01.01. LD.03.01.01; and HR.01.05.03) emphasize the importance of ensuring staff safety, which can extend to psychological safety in reporting concerns.
• The Leadership Standard (03.01.01) stresses the importance of staff engagement and participation in safety-related activities.

Key Actions:

• Create opportunities for staff to debrief after challenging incidents, focusing on what can be learned from near misses.
• Offer mental health resources and support to prevent burnout, which can reduce vigilance in identifying and reporting safety concerns.

6) Leadership Commitment and Visibility

Leadership commitment to safety is integral to creating an environment where near misses are routinely reported. TJC stresses the role of leadership in establishing a safety culture where staff feel empowered to report near misses without hesitation. Leaders must be visible champions for safety, continuously reinforcing the importance of reporting.

TJC Resources:

• The Leadership Standard (LD.03.01.01) requires leaders to prioritize safety and ensure that staff have the resources and support to report near misses.
• The Patient Safety Systems (PS) Chapter encourages leaders to actively engage in safety initiatives and to regularly communicate the importance of reporting incidents and near misses.

Key Actions:

• Ensure that leaders regularly review near miss reports and provide feedback to staff on actions taken as a result.
• Hold regular meetings focused on safety, where near miss reporting trends are discussed and improvement strategies are developed.

Conclusion: Strengthening Safety through TJC-Aligned Practices

Encouraging staff to report near misses is a key strategy for improving patient safety and care quality in behavioral health settings. By aligning with The Joint Commission’s standards and guidelines, behavioral health organizations can create an environment where staff feel supported and empowered to report near misses without fear of blame or retribution.

Building a robust safety culture requires clear reporting systems, leadership commitment, ongoing training, and a non-punitive approach to error reporting. By embracing TJC’s recommendations, behavioral health settings can reduce risks, improve patient outcomes, and foster a safer and more transparent care environment.

Barrins & Associates

Barrins can help you to integrate near miss reporting into your culture of safety.  Additionally, Barrins can assist you to identify, prioritize, and select, near misses that can be used in proactive risk assessments to improve the safety and quality of care you provide to the individuals you serve. Contact us today to learn more about our services.

Barrins & Associates – “Simplify, Deliver, and Thrive: Your Path to Compliance and Safe Care”