International patient safety learning systems: a qualitative key informant interview study with safety-critical industry experts

Background: Patient safety learning systems operate primarily at the national level, yet the potential for international sharing of safety intelligence 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.