Box A: Examples of aviation safety reporting systems

British Airways

• The British Airways Safety Information System (BASIS) is a tool for safety management, developed and introduced by British Airways in 1990 and now used by 150 organisations around the world.
• It supports the process of investigating possible breaches in safety and is predicated upon a philosophy that puts safety at the centre of the organisation.
• An open reporting culture is a key to the success: `... the fundamental principle behind BASIS is that an open, penalty-free reporting culture be developed and supported. This encourages staff to contribute high quality safety information without fear of recrimination.' To support the culture, letters are sent to staff thanking them for their report and giving them details of the investigation.
• BASIS produced a database of over 43,000 incidents for 1999. Through the analysis of trends, BASIS helps airlines and other related organisations to adopt strategies to prevent adverse events and to promote safety.

Aviation safety reporting system - the US federal system

• Eligibility for limited immunity from disciplinary action for non-criminal offences is a powerful incentive to report. No immunity is given if the event is deemed intentional; where there is a question of qualifications; or, if the report is filed after 10 days.
• The number of reports of events is around 30,000 a year. Data have been used to redesign aircraft, air traffic control systems, airports, and for the training of pilots.
• Management of the system is contracted out to an independent third party.

Box B Safety reporting systems in US hospitals

The Luther-Middleford Hospital in Eau Clare, Wisconsin

• In 1997, a team under a clinician, Roger Resar, undertook an assessment of errors in medication and found that patients were probably at risk of two to three drug errors during a stay.
• A non-punitive system of reporting was established, first in just one department but now throughout the hospital.
• Reports of errors from nurses and technicians rose by up to sevenfold in the first month after the system was introduced in spring 1998. The number of errors reported levelled off in time as changes to systems were put in place to tackle some of the underlying factors leading to the errors reported.
• The hospital has, as one of its stated objectives, `to provide safe care'. There is a commitment to safety within the hospital, and a determination to apply thinking about safety to everything it does.
• The hospital's president and CEO (Chief Executive Officer) says, `We have worked hard at changing the cultural fear of punishment. Now we tell people they'll get in trouble if they don't report an error - and they have a 48 hour period to let us know if something has gone wrong'.

The Veteran's Administration - the healthcare system for US veterans and their families

• The VA includes 172 hospitals and employs 200,000 people. Features of the patient safety system include a safety events registry to which staff are encouraged to report all incidents that caused significant harm to a patient.
• Reported errors are subject to analysis leading to corrective action and preventive measures, rather than punitive action (the sole exception being a criminal or a deliberately unsafe act).
• Individuals who suggest broadly applicable safety improvements qualify for bonuses of up to $5,000; institutions can receive up to $25,000.
• The head of the VA's National Center for Patient Safety, James Bagian, an engineer and former astronaut, says `The old model was, you stressed who was at fault. The new model is that we understand you do not come to work to make errors and we want to minimize the risk that you will do so.'