GOP Information
Organisation sharing the GOP
Related practices from PaSQ database
Federal Public Service of Health, Food Chain Safety and Environment (FPS


Incident reporting and learning system
Incident reporting and learning system
Reporting and learning systems
GOP Description
Implementation level
Clinical settings
Participatory hospitals: Acute, psychiatric and long term care institutions.
Implementing a reporting and learning system for (near-) incidents, to start analyzing (near-) incidents using Root Cause Analysis and to classify these incidents in order to enhance patient safety management.
Participatory hospitals
•The development or description of an incident and near-incident reporting and lessons learned system;
•Analysing five different incidents or near-incidents according to a retrospective analysis method and giving a description of the proposed improvement actions and formulated recommendations;
•Classifying these five analysed incidents according to the International Classification for Patient Safety (taxonomy) of the WHO, using and encoding at least the classes: type and characteristics of the incident and consequences for patient and organization (minimal dataset);
•Adding a blank copy of all reporting forms used in the institution
Timeframe implementation
Started in 2008, on-going project, hospitals will have to continue reporting incidents and analyse them to enhance patient safety.
Implementation tools available
XML export format, criteria, workshops and PowerPoint Presentations
Implementation cost
Depending on each hospital own year budget.
Method used to measure the results
Corrections received from NCP:
Yearly, the FPS collects information on the adherence to the program and results of initiatives of the participating hospitals. Hospitals fill in an electronic questionnaire with some qualitative (open questions) and quantitative questions. Thanks to the collection of this data, we’re able to analyse and see the evolution of the implementation of a reporting and learning system for (near-) incidents in each of the hospitals. Once we have analysed the data, we provide feedback by publishing a national report of the aggregated data (graphs and analysis)
These results are informing of the utilization rate of the learning system. How is the effectiveness of this procedure measured (change in the patient safety culture etc.)?
Analysis of the results
Analysis of the yearly reports allows the follow-up of the elaboration and implementation of the notification and learning system.
Implementation barriers
Did you find implementation barriers?
Please describe implementation barriers
Cost for small hospitals/institutions and reports not evaluated.
Describe the strategies used to overcome the barriers (If needed)
The FPS organizes on-going education (workshops for caregivers as well as for information technologists) and support by means of a web based helpdesk www.forum.icps-belgium.be in order to discuss the problems and find solutions.
Other information
Other information about the GOP that you would like to add (Link or attached document)
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