Abstract
The incident reporting system was established as one of the methods to make a prompt improvement after identifying the medical accident issues at Gunma University Hospital. There was a hospital reporting regulation for complication or the variance report introduced in 2010， but reporting an event or incident was actually determined depending on the judgment of each individual or department. While keeping everyone informed regarding a change in the variance report regulation， we strengthened cooperation among the departments and also enhanced an active notification system for problematic events. The number of reports from doctors has been increasing every year by 3.7 times from 217 reports in 2013 to 802 reports in 2016 before the accident clarification. Furthermore， we also found that the number of cases for an identical event reported by multiple types of occupations/jobs has also been increased markedly. Since the reports from doctors tend to be high-level events related to medical treatment， maintaining an awareness of a high-medical safety will be absolutely required to construct a culture of patient safety. It is considered that further examination would be necessary for sustaining a continuous system with additionally-fulfilling educational system or a system structure such as simplification for reporting.
