A national incident reporting and learning system in England and Wales, but at what cost?

Abstract

Recent high-profile failures in healthcare highlight the ongoing need for improvements in patient safety. Moreover, the fiscal challenge facing many health systems has brought the costs and economic efficiencies associated with improving quality (and safety) to bear. Currently, there is a lack of economic evidence underpinning resource allocation decisions in patient safety. Incident reporting systems are considered an important means of addressing these challenges by monitoring incident rates over time, identifying new threats to patient care and ultimately preventing repetition of costly adverse events. Uniquely, for more than a decade, the UK has been developing a National Reporting and Learning System to provide these functions for the English and Welsh health system(s), in addition to pre-existing local systems. The need to evaluate the impact of national incident reporting, and learning systems in terms of effectiveness and efficiency is argued and the methodological challenges that must be considered in an economic analysis are outlined.

Keywords:

• cost analysis
• efficiency
• incident reporting
• patient safety
• quality improvement

Financial & competing interests disclosure

This work was funded by healthcare quality improvement research grants awarded to the Department of Surgery and Cancer at Imperial College London. These include an NRLS research and development grant from NHS England. The authors have no other relevant affiliations or financial involvement with any organisation or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilised in the production of this manuscript.

Notes

¹High reliability organisations are defined as those that operate in hazardous settings with reliability and safety.

²Following advice from a former NPSA executive, 80% of NPSA expenditure is assumed to be NRLS development and operational costs.