International patient safety learning systems: a qualitative key informant interview study with safety-critical industry experts
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Background
Patient safety learning systems operate primarily at the national level, yet the potential for international sharing of safety data and learning remains largely unrealised. Other safety-critical industries, including civil aviation, nuclear power, and rail, have developed international incident reporting and learning systems whose design principles may offer transferable insights for healthcare.
Objective
To explore the views and experiences of safety-critical industry experts regarding the purpose, key functions and features, transferability, barriers, enablers, and incident priorities of a potential international patient safety learning system.
Design
Qualitative phenomenological study using semi-structured key informant interviews analysed with the five-stage framework analysis method.
Participants
Eleven international experts purposively sampled from safety-critical industries (healthcare, civil aviation, maritime, and railway) across six countries. Interviews were conducted by telephone or internet-based audio call between May and September 2019.
Results
Seven themes were identified: (1) purpose of an international patient safety learning system; (2) key functions; (3) key features; (4) transferability of learning; (5) enablers; (6) barriers; and (7) patient safety incident types appropriate for international sharing. Rare and emerging event detection emerged as the most distinctive value of an international system, a capability that cannot be replicated at national level. Critical functions included robust feedback loops, multidisciplinary analytical capability, and actionable recommendations. Key barriers, including blame culture, inter-organisational mistrust, and cross-border privacy legislation, were each amplified at the international level relative to their national-level equivalents.
Conclusions
This study provides the first cross-industry qualitative account of design requirements for an international healthcare patient safety learning system, highlighting transferable lessons from established industries alongside healthcare-specific challenges that require bespoke solutions.
