Learning from incidents in healthcare: the journey, not the arrival, matters

Incident reporting is widely recognised as an important method for improving safety in healthcare, and many countries have established their own incident reporting systems.1 However, the actual value of these systems is increasingly subject to debate.2 Reporting systems, both local and national, are overwhelmed by the volume of reports and fall short in defining recommendations for improving healthcare safety: ‘We collect too much and do too little’.3 The purpose of these systems is also under debate. The UK, for example, struggles to clarify whether incident reports should be used to help healthcare organisations learn, or whether they should help regulators and funders to make judgements.4 As healthcare inspectors tasked with running a national hospital incident reporting system (IL, SM and JV), we recognise the issues described above. In this article, we show how the theories in the evolving scientific literature on incident reporting apply to our situation. Our work since 2012 acts as an empirical example of how reporting systems could have an effect if they focus on the learning process within hospitals instead of on solutions for reported safety issues. As TS Eliot is quoted as saying: “The journey, not the arrival, matters.” ### The conception of ‘incident’ changes over time Vincent and Amalberti argued that safety in healthcare is a moving target, because innovation and improving standards in healthcare alter the conceptions of both harm and preventability.5 This dynamic view of healthcare safety can be illustrated by the 1996 Dutch legal definition for a sentinel event (SE), the most serious class of incidents that healthcare organisations are mandated to report (see box 1). Since rising standards of care influence the way incidents are judged, an incident in 2005 can be judged differently in 2015 using the identical definition.6 Moreover, the standards of the healthcare quality community change faster, because they …