Clinician Adverse Event Reporting Experience Survey

Welcome to the Clinician Adverse Event Reporting Experience Survey. This survey explores your experiences with reporting adverse events and near misses, including system usability, barriers, and feedback culture. Your responses will help identify practical improvements to reporting processes and patient safety. • Participation is voluntary. You may stop at any time. • There are no right or wrong answers — we want your honest perspective. • All responses are confidential and will be reported only in aggregate. • Estimated time: approximately 12 minutes. By continuing, you consent to participate.

Does your role involve direct or indirect patient care, or oversight of patient safety or quality processes?

• Yes
• No

Approximately how many adverse event or near-miss reports have you submitted in the past 6 months?

• 0
• 1–2
• 3–5
• 6–10
• 11–20
• More than 20

Overall, how easy or difficult is it to file a report in your primary reporting system?

How confident are you that your reports capture all the details needed for learning and follow-up?

I feel safe reporting adverse events and near misses without fear of blame or repercussions.

Please rank the following potential improvements from most to least impactful for your reporting experience.

1. Simpler or faster reporting form
2. Clearer guidelines on what to report
3. Better feedback after submitting a report
4. More training or job aids
5. Stronger no-blame culture
6. Better integration with the EHR

What is your primary role?

• Physician
• Nurse
• Advanced practice provider (NP/PA)
• Pharmacist
• Allied health professional
• Quality/safety professional
• Administrator/manager
• Other (please specify)
• Prefer not to say

Thank you for completing this survey. Your responses are confidential and will be analyzed in aggregate to identify actionable improvements to reporting processes and patient safety. If you have questions, please contact [survey administrator].

When a near miss occurs in your work area, how often do you report it?

• Always
• Often
• Sometimes
• Rarely
• Never
• Not applicable — I have not witnessed a near miss in this period

Typically, how long does it take you to complete one report?

• Under 5 minutes
• 5–10 minutes
• 11–20 minutes
• 21–30 minutes
• More than 30 minutes

The required fields in the reporting system capture the information needed for learning and follow-up.

After submitting a report, how often do you receive feedback on the outcome or follow-up actions within 30 days?

• Always
• Often
• Sometimes
• Rarely
• Never
• Not applicable — I have not submitted a report

Based on your responses throughout this survey, what one change would most improve the ease or completeness of adverse event reporting in your practice?

What is your primary clinical setting?

• Inpatient hospital
• Emergency department
• Ambulatory/clinic
• Surgery/perioperative
• Behavioral health
• Long-term care
• Home health
• Other (please specify)
• Prefer not to say

The steps required to submit a report are clear and easy to follow.

Which of the following factors most hinder your ability to report events or to report them completely? Select all that apply.

• Limited time or workload
• Unclear what qualifies as reportable
• System is cumbersome or slow
• Duplicate entry across systems
• Lack of training or guidance
• Concerns about blame or repercussions
• Uncertain where to submit
• Little or no feedback after reporting
• Technical issues or EHR integration problems
• Other (please specify)

Have you received any training on adverse event or near-miss reporting in the past 12 months?

• Yes
• No
• Not sure

We'd like to explore your reporting experiences in a bit more depth. An AI moderator will ask you a couple of brief follow-up questions about your biggest challenges or suggestions for improving adverse event reporting.

How many years have you been in clinical practice?

• 0–2
• 3–5
• 6–10
• 11–20
• 21+
• Prefer not to say

How easy or difficult is it to locate and access the reporting form or system?

Which of the following training formats or job aids would help you report more easily and completely? Select all that apply.

• One-page quick guide or checklist
• Short video (3–5 minutes)
• In-system tooltips or prompts
• Live refresher session
• Case-based examples
• None of the above

Which best describes your typical work schedule?

• Day
• Evening
• Night
• Rotating
• Varies
• Not applicable
• Prefer not to say

How easy or difficult is it to select the correct event type and category?

In which region is your primary workplace located?

• U.S. Northeast
• U.S. Midwest
• U.S. South
• U.S. West
• Outside the U.S.
• Prefer not to say

How easy or difficult is it to enter the event narrative and supporting details?