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Abstract
Patient safety reporting and learning systems (PSRLS) are tools to promote patient safety culture in healthcare organisations (HCO). Many PRSLS are locally developed. WHO Global Action Plan on Patient Safety 2021–2030 urges governments to deploy policies for healthcare risk management including PSRLS. The Ministry of Health of Catalonia (MHC) faced challenges in addressing quality and patient safety (Q&PS) issues due to disparate information systems. To address these challenges, the MHC developed a territorial PSRLS and embedded it in the Quality and Patient Safety Strategic Plan of Catalonia 2023–2027 (QPSS Plan Cat).
Methods Four-step process: (1) creation of a governance model, a web platform and reporting forms for a PSRLS in Catalonia (SNiSP Cat); (2) SNiSP Cat roll out; (3) embed SNiSP Cat information in the accreditation model for HCO and the PS scorecard; (4) Development of SNiSP Cat within the QPSS Plan Cat 2023–2027.
Results The SNiSP Cat is in use by 63/64 acute care hospital (ACH), 376/376 primary healthcare teams (PCT) and 17/98 long-term care facilities (LTCF). 1335/109 273 professionals were trained. Until 2022, 127 051 incidents have been migrated and reported (2013–2022). The system has generated three comprehensive risk maps for HCO: one for ACH, including patients’ falls, medication, clinical process and procedures; second for PCT, including clinical process and procedures, clinical administration and medication; and a third for LTCF, included patients’ falls, medication, digital/analogical documentation. SNiSP Cat provided information to support 53 standards out of 1312 of the ACH accreditation model and 14 standards out of 379 of PCT one. Regarding the MHC patient safety scorecard, 14 indicators out of 147 of ACH and 4 out of 41 of PCT are supported by SNiSP Cat data.
Conclusions The availability of a territorial PSRLS (SNiSP Cat) allows MHC leads the Q&PS policy with direct information, risk maps and data support to the standards for the Catalan accreditation models and PS scorecard linked to incentivisation, turning the SNiSP Cat into a driven tool to implement the Quality and Patient Safety Strategic Plan of Catalonia 2023–2027.
- Incident reporting
- Safety culture
- Health policy
- Risk management
Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The data from SNiSP Cat are owned by the Ministry of Health of the Catalan Government. They are accessible upon reasonable request. All pertinent data for the study are either included in the article or provided as supplementary information.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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WHAT IS IT ALREADY KNOWN ON THIS TOPIC?
Patient safety reporting and learning systems (PRSLS) serve as valuable instruments for fostering risk management within healthcare systems. However, its effectiveness has been a subject of debate, primarily due to the insufficient engagement of healthcare leaders and policy-makers. The omission of the inclusion of PRSLS as a crucial element of quality and patient safety plans has contributed to this uncertainty.
WHAT THIS STUDY ADDS?
Our study underscores the importance of engaging policy-makers, such as the Health Department of Catalonia, to prioritise patient safety policies and ensure compliance with regulatory quality and safety standards. Through the development of a territorial PSRLS integrated into the Quality and Patient Safety Strategic Plan 2023–2027 for the Catalan healthcare system, policy-makers gain awareness of healthcare challenges in real time. This commitment to implementing territorial PSRLS empowers stakeholders to gain timely insights into healthcare risks, enabling informed policy decisions aimed at resolving them.
HOW MIGHT THIS STUDY AFFECT RESEARCH, PRACTICE OR POLICY
Fostering a patient safety culture among policy-makers, healthcare organisation managers and professionals is essential for the successful implementation of a territorial patient safety reporting and learning system (PSRLS), which holds the potential to substantially reduce preventable harm associated with healthcare delivery within a specific region. This strategic initiative enables the timely identification and addressing of quality and patient safety challenges as they arise, informing future health policy development to enhance patient safety in healthcare services.
Background
The Institute of Medicine’s report ‘To err is human’ addressed the burden and cost of low healthcare quality and, moreover, quantify the harm caused to patients and their families.1 It placed patient safety as the basic dimension of healthcare quality in health services. Today, many healthcare systems report quality and safety indicators providing an impetus for quality improvement in health systems worldwide.2
Nevertheless, some systems still have difficulties crossing the quality chasm.3 Top-performing organisations share common features, including a positive ‘organisational culture’ linked to patient safety4 based on clinical risk management strategies and patient safety programmes.5 One crucial tool is the development of a patient safety reporting and learning system (PSRLS).
In 2017, the WHO produced a technical report6 with recommendations to develop PSRLS. The adoption of Global Patient Safety Action Plan 2021–20307 by the World Health Assembly called on governments to enable organisations to deploy tools that reduce the preventable harm associated with healthcare provision with the promotion of PSRLS, as stated in the strategic objective 6.
However, despite the commitment of many national and international leaders to promote PSRLS, there are still barriers to widespread its use.8 Mahmoud et al 9 identified barriers for the effective use of PSRLS in healthcare organisations (HCOs). The barriers affected all the reporting process such as difficulties in reporting at the point of care, lack of experience to report, lack of feedback after reporting, lack of time due to overload of work, confidentiality issues, lack of support to professionals involved in an adverse event, lack of training and lack of organisational culture and support. These barriers showed that PSRLS implemented without a Q&PS plan that guided healthcare systems to implement ameliorations are useless. Therefore, health policy initiatives at national level are crucial to boost the effectiveness of PSRLS.
The Department of Health of Catalonia Government (DHC) is responsible for ensuring healthcare quality and patient safety10 to a population of 7 700 000 inhabitants. The DHC has three regulatory tools to address it. The first is the legal obligation to have a PSRLS for authorisation and registration of HCOs in the territory.11 The second is the implementation of an accreditation model for acute care hospitals (ACH)12 and primary care teams (PCT)13 every 3 years. The models include standards about reporting events to the DHC. The third is the fact that all healthcare services contracted by health authorities ought to comply a set of patient safety indicators linked with reimbursement.
There were different PSRLS in HCOs in Catalonia. The first was SiNASP (National Patient Safety Reporting and Learning System)14 and since 2013, the DHC provided a PSRLS (TPSC Cloud platform V.8.0)15 to public HCOs to comply with patient safety regulations. However, the TPSC Cloud was not interoperable with the DHC information systems, and it was difficult to make improvements in the PSRLS platform.
In 2021, the DHC created a patient safety technological platform to manage healthcare risks in HCO, the Patient Safety Platform of Catalonia (PSP Cat).16 It included a proactive application (PROSP Cat)17 to control work environment risks by performing daily checklist of essential tasks as to validate in every shift the code blue crash cart. Regarding reactive risk, the PSP Cat included a territorial PSRLS platform. This paper provides a comprehensive overview of the implementation process of the Patient Safety Reporting and Learning System of Catalonia (SNiSP Cat) led by the Department of Health. It also outlines key outcomes attained during the system’s initial year, along with a prospective development plan aligned with the Quality and Patient Safety Strategic Plan for Catalonia spanning 2023–2027.
Methods
The DHC developed a 4-step process to implement a new PSRLS.
Step one: a governance model, a platform and reporting forms within the regulatory framework
The MHC invested in building a technological platform for integrating patient safety information systems in the Patient Safety Platform of Catalonia (PSP Cat). The MHC developed a governance model to bring together all healthcare stakeholders in the Catalan health system to promote the use of the PSP. The PSP Cat include three patient safety tools: PROSP Cat (proactive strategy), SNiSP Cat (reactive strategy) and QCSP Cat (a patient safety scorecard for HCO). The PSRLS (SNiSP Cat) has a specific strategic commission, a quality and patient safety experts’ group and a technical group that includes representation from many healthcare entities in the territory (online supplemental file 1: PSP Cat governance model). This collaborative approach ensured a wide consensus on the system’s design and for the future updates of the platform. The technical group comprised experts with extensive experience in using other PSRLS.
Supplemental material
The PSRLS web platform is stored in the servers of the Government of Catalonia and accomplishes accessibility and cybersecurity certification monthly by the Cybersecurity Agency of Catalonia.18 The use of the platform is free of charge for all HCO of the comprehensive public health system of Catalonia (SISCAT, Integrated Health System of Catalonia).19 The governance groups oversee the agreement on the new functionalities and improvements that will be included in future SNiSP Cat version by the technical group in the platform.
Regarding regulatory framework, to guarantee Spanish regulations and to protect reporters and PSRLS managers, the PSRLS in Catalonia considered all territorial, national and European regulations.11 19–24
The reporting form adhered to both national and territorial standards, exemplified by the Reporting and Learning System of the Spanish Health Ministry (SiNASP).25 26 These parameters encompassed content specifications and alignment with the WHO 2009 International Classification for Patient Safety27 (online supplemental file 2: SNiSP Cat reporting form) with three distinct forms tailored to ACH, primary healthcare facilities (PCT) and long-term care facilities (LTCF). A system manager’s guide was created to get most of the functionalities of the PSRLS for system managers in each HCO (online supplemental file 3 SNiSP Cat manager’s user guide).
Supplemental material
Supplemental material
Step two: a process to roll out the SNiSP Cat in HCO
The HCOs within Catalonia undergo a structured process to obtain SNiSP Cat, commencing with the formal submission of an application to the MHC. If prior PSRLS systems were in place, a consensus was reached regarding their migration. Post successful migration, a comprehensive training regimen is initiated, encompassing both system managers and healthcare professionals.
The designated system managers in each organisation have the responsibility of tailoring the PSRLS form to align with their distinctive quality and safety organisational framework and culture. This integration is crucial in embedding the tool within their overarching HCO Q&PS plans. Subsequently, the appointment of unit or process-specific managers becomes imperative. Their role encompasses the review of reported incidents in a peer-review process and close reported incidents. PSRLS managers in each HCO guide the inclusion of ameliorating plans in the HCO. In relation to sentinel events, HCO directors are promptly alerted and collaborate with the system manager to activate adverse events response teams. These teams are mobilised to assist the patient affected (first victim), the professional team involved (second victims) and to execute the response plan for adverse events within the HCO (third victim). The range of managers within the reporting system may differ across the HCO, including care process managers overseeing surgical or ambulatory care, formal clinical commissions or units specifically focused on risk management. This variation is influenced by the distinct quality model adopted by each organisation.
The MHC has created two specialised online training courses catering to healthcare professionals at the MHC website (http:\\seguretatdelspacients.cat). The first course is tailored to enhance the proficiency in reporting among health workers. The second course is designed for system managers. In addition to the online courses, the MHC organised face-to-face courses promoting networking opportunities among HCOs. This initiative seeks to enhance collaboration and communication within the healthcare community, fostering a shared commitment in the Catalan health system to advancing patient safety.
The SNiSP Cat provides the HCOs with standardised data analysis, presenting a comprehensive overview of incidents, contributing factors and factors for improvement through graphical representations. Users also have the option to download data for in-depth analysis. Moreover, the MHC has the capability to analyse global information to construct risk maps according to healthcare lines.
Step 3: embed SNiSP Cat information in the accreditation models for HCO and in the patient safety scorecard for incentivisation
In alignment with accreditation standards and patient safety indicators, every 3 years, HCO that belong to SISCAT are mandated to undergo accreditation. This accreditation model entails strict adherence to a defined set of patient safety indicators to qualify for incentivisation. A meticulous search was undertaken to identify specific standards and indicators that can be derived from SNiSP Cat information and integrated into the incentivisation process (see online supplemental file 4). As a result, HCO will be motivated to streamline reporting processes for their healthcare workers.
Supplemental material
Step 4: role of SNiSP Cat in the Quality and Safety Strategic Plan 2023–2027 of Catalonia (QPSS Plan Cat)
The QPSS Plan Cat was crafted following a comprehensive process that commenced with a diagnostic evaluation of quality and patient safety within the Catalan health system, followed by strategic delineation. The diagnostic phase entailed conducting a Strengths, Weaknesses, Opportunities, and Threats (SWOT) survey targeting healthcare professionals, managers, quality and safety officers, alongside another survey directed at patients. Subsequently, the strategic definition phase was informed by the findings of the SWOT analysis, supplemented by official data on quality and patient safety, and feedback from healthcare professionals on preliminary drafts. The process and plan were published elsewhere27 and in the MHC website.28
In terms of the SNiSP Cat rollout, the plan stipulates its initial implementation within public HCOs in Catalonia, covering 64 ACHs, 376 PCTs and 98 LTCFs, comprising an estimated workforce of 21 924 medical professionals, 32 720 nurses and 54 629 other professionals.29 Subsequently, the plan outlines the expansion of the SNiSP Cat to private HCOs in Catalonia.
We present the results reached out in the 2 years process to develop a territorial PSRLS in Catalonia (SNiSP Cat) and a detailed description of future actions included QPSS Plan Cat of the Ministry of Health, Government of Catalonia.
In figure 1, there is a visual summary of steps to develop a PSRLS in Catalonia.
Steps to develop the patient safety reporting and learning system of Catalonia (SNiSP Cat).
Results
Step 1 results: governance model, platform and reporting forms
The SNiSP Cat is the name of the new PSRLS in Catalonia. It began its operation in December 2021. Since then, SNiSP Cat included 17 versions with 516 new functionalities by June 2023, improving the experience of professionals and system managers. New functionalities include reporters’ feedback, reporters’ private area, the possibility to send internal emails and the availability of different tools for incident analysis such as the London protocol, the Ishikawa diagram and the analysis of barriers within the platform.
Step 2 results: roll out of SNiSP Cat in HCOs
The SNiSP Cat is currently accessible in 63 out of 64 ACH, 376 out of 376 PCT, and 17 out of 98 LTCFs in public provision HCO. To date, 6625 professionals have reported incidents, while 1599 professionals have chosen to have a private area to keep track their incident reports and receive the finalised ameliorating plan resulting from incident analysis.
A data migration of 110 961 incidents from previous PSRLS to SNiSP Cat was performed. The SNiSP Cat have 117 541-reported incident until December 2022. The distribution by type of HCO follows 82 097 incidents from ACH (70%), 31 663 from PCT (27%) and 3781 from LTCF (3%) as presented in figure 2.
Reported incidents 2013–2022.
Nurses, midwives and auxiliary nurses comprise 70% of global reporters in the fields of ACH and LTCF. In the realm of PCT reporting, the distribution of professional profiles is more balanced, with doctors and pharmacists accounting for 36.74% and nurses for 42.17%.
Considering patient age, more than 70% of incidents reported referred to patients with more than 60 years old (64.63% ACH, 44.88% PCT and 88.10% LTCF).
Regarding PS incidents classification by degree of harm and probability of occurrence by healthcare levels are detailed in table 1. The extreme incidents are below 0.5% in all levels. Major incidents represent approximately 1% (ACH 1.06%; PCT 0.87%; LTCF 0.5%); moderate incidents accounts for 12% (ACH 13.22%; PCT 6.09%; LTCF 15.31%) and minor ones for 15.97% (ACH 18.18%; PCT 8.86%; LTCF 27.59%). Insignificant or incident without harm are the more frequently reported incidents to the system accounting for more than 70% (ACH 67.07%; PCT 83.86%; LTCF 56.25%). Regarding probability of occurrence, a third of the incidents reported (28.78%) are considered very frequent (ACH 29.79%; PCT 26.15%; LTCF 28.83%).
Severity and likelihood of reported incidents, 2013–2022
In figure 3, the risk maps by types of incidents for each healthcare line are displayed. The five most relevant incident types accounting for 80% of reported incidents from the three healthcare lines are highlighted. For ACH, the risk map includes patients’ falls, medication, clinical process and procedures, medical devices and equipment, digital and analogy documentation. For PCT facilities, the risk includes clinical process and procedures, clinical administration, medication, digital and analogic documentation, medical devices and equipment. For LTCF, the main risks are patients’ falls, medication, digital and analogic documentation, medical devices/equipment and patients’ behaviour.
Risk maps by incidents type and healthcare lines.
Table 2 describes the three main contributing and mitigating factors per healthcare line. Among contributing factors, the staff factors were involved in a third of global-reported incident (31.82%) (30.44% ACH; 36.12% PCT; 20.69% LTCF) being Performance factors: Rule based (misapplication of good rules) the more frequently reported ones. The patient factors (24.08%) are more frequently reported in ACH and LTCF (ACH 29.30%; PCT 9.74%; LTCF 48.59%) like the work/environment factors (8.49%) (ACH 10.01%; PCT 4.69%; LTCF 12.08%). However, the organisational and service factors (19.43%) (ACH 15.92%; PCT 28.27%; LTCF 10.29%) and the external factors (6.29%) (ACH 4.83%; PCT 9.87%; LTCF 3.22%) were more prevalent in PCT. Considering mitigating factors, those direct to the staff accounted for 47.07% (ACH 49.85%; PCT 40.28%; LTCF 44.93%) and were the more prevalent. Those direct to the patient (23.17%), direct to the organisation (18.80%) and to the agent (10.94%) were similarly distributed among different healthcare lines. Table 2 shows a detailed description of the main contributing and mitigating factors of reported incidents per healthcare line.
Contributing and mitigating factors of reported incidents, 2013–2022
The templates for the London Protocol and Ameliorating Plan were integrated at the beginning of 2023 as part of the development of the QPSSP 2023–2027. Throughout 2023, a total of 134 risk extreme or sentinel events were reported. Among these, 28 events had the London Protocol fulfilled, and 54 events had a detailed ameliorating plan.
Step 3 results: SNiSP Cat information in the accreditation models and patient safety scorecard
Regarding accreditation models, SNiSP Cat could provide information to accomplish 53 standards out of 1312 from ACH and 14 PCT standards out of 379 of the accreditation models. Regarding the patient safety scorecard linked to reimbursement, SNiSP Cat could provide information to accomplish 14 ACH indicators out of 147 and 4 out of 41 PCT indicators for incentivisation (online supplemental file 4).
Step 4 results: SNiSP Cat in the quality and safety strategic plan 2023–2027
The plan consists of 8 strategic lines, encompassing over 300 carefully crafted actions. It places particular emphasis on enhancing the reporting and learning system in Catalonia, with 10 strategic actions dedicated to this purpose. The QPSS Plan 2023–2027 incorporates the SNiSP Cat in at least one strategic action per line (see figure 1).
The first strategic line focuses on health policy and advocates for the enactment of a National Patient Safety Law to safeguard reporters and PSRLS information from being used in legal proceedings. This initiative depends on the initiative of the National Health Ministry.
The second line emphasises leadership and professional engagement, integrating second victim support units into the analysis of major or extreme risk incidents reported and it is already being implemented in different organisations.
The third line centres on Q&PS models and tools, advocating for the adoption of safe practices identified through risk maps. It also proposes adapting SNiSP Cat reporting forms for other healthcare sectors, such as mental health, and introducing incident analysis tools like the London Protocol and an Ameliorating Plan which had been introduce in early 2023.
Line 4 focuses on evaluation and learning, aiming to make SNiSP Cat information accessible to meet Q&PS scorecard and accreditation model standards. This implementation process aligns with the results of step 3.
Line 5 prioritises knowledge, research and innovation, aiming to enhance training and scientific publications related to PSRLS. We are currently developing training programmes aimed at reaching healthcare professionals from all HCOs that have applied to join.
Line 6 addresses effective communication by proposing the development of periodic SNiSP Cat newsletters for HCOs. The newsletter is under construction.
Line 7 emphasises alliances and networking, encouraging collaboration with the Spanish Health Ministry and the WHO. The MHC actively participate in national and international Q&PS initiatives.
Line 8 is dedicated to enhancing patient experience and citizen engagement, proposing the option for citizens to report patient safety incidents to the SNiSP Cat. However, this feature is still pending development.
Discussion
The SNiSP Cat serves as the new PSRLS, which will be gradually implemented within the Catalan health system as a fundamental tool within the healthcare risk management strategy outlined in the QPSSP 2023–2027. This initiative is a health policy commitment of the MHC. It enables HCO to align with the regulatory mandates set forth by the MHC. This encompasses for HCO the mandatory existence of a PSRLS and the obligatory reporting of patient safety indicators o the health authority for reimbursement and accreditation process every 3 years for ACH and PCT. Regarding professionals’ engagement, the SNiSP Cat web platform ease the linkage of incident reporting to the electronic health record. Reporting forms are adapted to ACH, PCT and LTCF specificities to boost reporting. The system provides tools for the incident analysis, ensures confidentiality and promotes the implementation of safe practices through the amelioration plan linked to incident closing report. SNiSP Cat managers within each HCO address amelioration plans into the Q&PS organisation plans. Receiving all reports, the MHC can generate updated risk maps for both individual HCO and the entire system. Consequently, the MHC will drive initiatives using various tools, such as formulating guidelines for safe practices and evaluating their implementation through the PS platform. These are key action for the success of PSRLS30 and that failed in other national PSRLS.31
In a recent international study32 about recommendations for national PSRLS, experts agreed that reporting is a valuable mechanism for identifying organisational safety needs. Our study demonstrated that a national PSRLS is highly beneficial in addressing issues such as medication errors, device failures, hospital-acquired infections, and never events, as these challenges often require nationwide solutions.
Compared to the 2010–2013 PSRLS data for ACH14 in Catalonia, nurses remain the primary reporters, mainly documenting incidents occurring in hospital wards related to medication, followed by patient falls. Now incident types turn into patients’ falls first and medication the second type. There is an increase of reported incidents without harm. The ACH incident trends (figure 2) showed an increase on reporting along the years. Studies conducted in hospital settings internationally suggest that incidents occur in approximately 9%–12% of admissions. These incidents commonly involve the diagnostic process, medication administration, technical procedures and surgeries.33 Regarding national data from SiNASP in 2022 which encompasses 10 regions (30% of Spanish inhabitants), the total number of incidents reported rose up to 4698 incidents mainly regarding medication (17%) followed by procedures and clinical administration (16.8%).34 Nevertheless, falls did not appear as one of the most relevant nature of incidents as in our system.
The PSRLS fosters the development of a regional and organisational risk map as a pivotal role in driving the implementation of the QPSS Plan 2023–2027. Risk maps shed light on critical areas such as the prevalence of patient falls in ACH and LTCF, a concern of global significance.35 Additionally, the evolving landscape of primary healthcare exhibits a shifting pattern with an increasing frequency of incidents tied to procedures and clinical administration, surpassing incidents linked to medication. It may reflect the benefit of international efforts on reducing medication harm36 and support the implementation of safe practice from health policy perspective. Avery et al showed that diagnoses and medication errors were the most impactful errors in PC facilities in England, quite like the Catalan system.37 Regarding national data from SiNASP in 2022,34 the total number of incidents reported was 228, 29% (66 incidents) about medication and 21% (48%) clinical administration.
As SNiSP Cat spans over all HCO within the health system, it becomes crucial to emphasise the quality of reporting and analysis. The process of incident reporting involves professionals hailing from diverse backgrounds and varying levels of organisational familiarity. Consequently, the assessment of severity and the likelihood of incidents can exhibit considerable variability. Hence, to mitigate the diversity in assessments, offering concrete examples for rating the Severity-As-Certainty (SAC) scale proves to be advantageous. New Zealand Health Quality and Safety Commission is currently developing a tailored SAC assessment framework aimed at enhancing the evaluation of recurrent incident types, providing specific examples to healthcare providers.38 It will be an immediate training challenge to implement in our system. Nevertheless, as suggested by Koike et al, the effectiveness of the SNiSP Cat should be rigorously evaluated to make improvements on the safety of the healthcare system provision39 through safe practices as interventions to eliminating patient misidentification.40
Another improvement aspect to consider is the patient safety taxonomy used in PSRLS for international comparisons. The WHO taxonomy belonged to 2009. Therefore, it would be time to an international updated in the light of the Global Action Plan on Patient Safety 2021–2030. Incident types, contributing and mitigating factors should include new healthcare issues as the impact of health information technology41 and bioethical issues.42 Some countries43 44 and some specific healthcare areas as surgery45 or medication46 are already adapting taxonomy to improve reported incident analysis.
The ability of SNiSP Cat to reclassify incidents within the criteria of the MHC accreditation model may provide valuable information for Quality and Patient Safety (Q&PS) assessments in Healthcare Organizations (HCO) in Catalonia. The pursuit of meeting accreditation standards and patient safety indicators, which are essential for securing funding, underscores the need to enhance SNiSP Cat information. This elevation of its role is critical, as highlighted in the OECD report on the integration of healthcare quality indicators in HCOs across Europe.47 Another challenge in the rollout of the QPSSP 2023–2027 is the development of specific reporting forms for mental health organizations, as they have unique aspects that need to be considered for improvement48 and for emergency services. Regarding patient involvement, some countries, such as New Zealand, have launched new patient safety policies to involve consumers49 in the incident analysis. An immediate action in our system is to report patient complaints associated with adverse events through the customer services of HCOs and enter them into the system. This will facilitate the creation of an amelioration plan to be included in the HCO's Quality and Patient Safety (Q&PS) plan. Currently, these complaints are not reported, yet they may offer important insights for patient safety.50 Finally, opportunities should be developed for patients’ direct reporting into the SNiSP Cat as in other countries regarding medications.51
The main limitation of SNiSP Cat development is intricately tied to the implementation of the QPSSP 2023–2027. Monitoring the execution of the plan is imperative, facilitated through the health information platform PSP. This involves the extension of the SNiSP Cat to private providers and the submission of Q&PS reports from HCOs providing them with feedback. However, changes in health policy may directly affect the commitment to investment and executing the plan.
The main strength of SNiSP Cat development lies in Catalonia’s regulations, which mandate all HCOs to have a PSRLS in place for registering adverse events. This step is crucial for the success of the SNiSP Cat.
Conclusions
The Health Department of Catalonia has developed the SNiSP Cat, a territorial PSRLS. It will be accessible to all HCOs and ensure compliance with quality and safety regulations. It integrates with electronic medical records for incident reporting and analysis. System’s managers can implement ameliorating action plans from analysis into organisational quality and safety plans. Moreover, the SNiSP Cat is a crucial tool for executing the 2023–2027 Quality and Patient Safety Strategic Plan, providing vital data for accreditation and incentivisation of HCOs.
Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The data from SNiSP Cat are owned by the Ministry of Health of the Catalan Government. They are accessible upon reasonable request. All pertinent data for the study are either included in the article or provided as supplementary information.
Ethics statements
Patient consent for publication
Ethics approval
Not applicable.
Acknowledgments
We would like to thank everyone who directly or indirectly participated in the development and roll out of the SNiSP Cat and particularly to all healthcare professionals who are reporting to learn, improve and make a safer healthcare system in Catalonia.
References
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
X @PilarAstier
Contributors GO-O oversaw the entire implementation of the project and is responsable for the overall content. CP-R, MG-B, MR-T and JC-G comprised the strategic committee and developed the conceptual framework of the manuscript. IH-G, EL-S, NM-C, NH-V and M-PA-P authored and crafted the manuscript, along with creating tables and figures for various drafts. DA-V and EV-M were responsible for the technological advancement of the web platform and contributed data for analysis. All authors have reviewed and approved the final version of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.