From Close Calls to Safer Systems: Rethinking Near Miss Reporting in Healthcare

After decades of focus on improving patient safety, we have seen meaningful progress in key areas like hospital-acquired infections, pressure ulcers, and falls. However, across all disciplines, clinical and administrative leaders, frontline staff, and key industry stakeholders continue to see preventable harm persist. Around one in ten patients experience harm in their care journey, and more than 50 percent of that harm is preventable.  

Several factors contribute to this reality, including safety culture gaps, provider fatigue, siloed safety data, and an increasingly complex healthcare system that is at the crossroads between technology and human decision-making. The majority of healthcare organizations are living on the defensive, urgently responding after harm occurs, rather than having the tools or bandwidth to proactively address the many precursor events that serve as early signals before patient harm occurs.

To truly drive safety at scale, healthcare organizations will have to look beyond just adverse events and better leverage insights from one of the most valuable, but often underutilized, sources of safety data: near misses.  

Near misses: An early warning sign with significant value 

Identifying and analyzing near-miss data can be a superpower for health systems, as these trends can allow leaders to prognosticate the future. While these incidents do not result in harm, they often reveal the same system-wide vulnerabilities that can lead to adverse events if not properly addressed. In fact, it is estimated that there are between three and 300 near misses for every adverse event that occurs.  

A near miss could be something as simple as a communication error leading to unclear instructions, or potential medication errors, such as a nurse realizing a patient has been prescribed an incorrect medication dosage before administering it, or other forms of normalized deviance that have permeated your culture of safety.

Near-miss events should comprise approximately 44% of the total safety reports within an organization. Despite this, they still remain significantly underreported across the industry. A fear of blame, a lack of a strong safety culture, siloed safety data and reporting systems, and the regulatory amplification of harm event reporting have too often marginalized the opportunity for deep analysis of near-miss data.  

Developing an effective good catch program

Establishing and maintaining a “good catch” program is one of the first steps hospitals and health systems can take to capture necessary insight from near misses. These programs provide an incentive-based, non-punitive reporting environment, helping to reinforce a culture of transparency and accountability. They also shift teams away from fixating solely on the negative context of preventable harm and reorient them toward the far greater number of good catches happening across every hospital unit. 

Ultimately, focusing on good catches has the added benefit of being a moral booster that can provide another reason to infuse positive celebratory energy into the already stressful setting of any clinical environment. 

The most successful good catch programs balance data and storytelling, sharing these common characteristics: 

• User-friendly: Making it readily accessible for anyone on the team to report a near miss ensures staff feel more inclined to make a report when necessary.  
• Well-communicated and reinforced: Employees should feel assured that information collected will not result in a reprimand.  
• Action-oriented: The program includes clear processes for follow-up, ensuring all reports lead to corrective actions and that data-driven interventions are put into place to prevent future events.
• Embraces local creativity: The impact of creativity is often underestimated. When teams are given the space to celebrate good catches, they often find meaningful, unexpected ways to do so. 

Combining frontline insight with technology

Incident reporting has historically been labelled as a tedious, paper-based process. However, advancements in event reporting software are now enabling healthcare leadership and risk management professionals to better understand the underlying causes that lead to safety events. These tools help streamline the reporting process through digital data entry, reducing the amount of time spent on administrative tasks and enabling staff to focus more on patient interaction.

Reporting systems that are capable of EHR integration also provide access to real-time patient information, allowing immediate follow-up documentation and analysis, while dashboards and analytics provide insight into events in real-time, making it easier to collect and analyze data across departments, track trends over time, and identify areas for improvement.

These tools can also be easily blended into clinical workflows to prevent further burden. For example, leadership can add shortcuts to a reporting tool in all terminals and devices, or even place QR codes in strategic locations throughout facilities for easy access.  

Making near miss learning a leadership priority

Healthcare leadership should approach system-wide reporting as a tool for learning and growth, rather than only a compliance requirement. Doing this requires reinforcing psychological safety around incident reporting. When staff feel empowered to speak up, the entire organization, and most importantly, the patients benefit from these shared insights.  

Every effective good catch program requires leadership buy-in to realize its full potential; processes to ensure near misses lead to visible action must be woven into the broader safety strategy from the top down. 

Throughout my career and as a physician leader, I have seen all kinds of “good catch” awards, from CEO-led ceremonies to unit-based celebrations, and they all help us better identify early signals of harm while also elevating team morale. The most successful programs strike a balance between the unit level and the highest levels of leadership. 

The everyday actions that reinforce this culture are just as important: 

• Recognize people at all levels: When a CEO comes to the unit to acknowledge a good catch, or when those moments are woven into broader employee appreciation events where staff can share their stories, it encourages more of that behavior.
• Acknowledge the small moments: A simple “good catch” or “thank you” in real time goes a long way.
• Make it personal: Even small gestures like handwritten notes from leadership can have a lasting impact and make staff feel valued. 

These actions stay with you long after the shift ends. Personally, I will never forget the young lady I saw as an Emergency Medicine resident. She was in the ER for a headache, but mentioned that she had a family history of aortic aneurysm. While she did not have any abdominal pain, my curiosity inspired me to bring the ultrasound machine to her bedside and check her abdominal aorta, where I identified an early, asymptomatic aneurysm. While the satisfaction of helping her was more than enough, I will never forget my attending pulling me aside and saying, “That was a good catch, Testa. You may have just saved her life.”

Turning signals into safer systems  

Near misses provide some of the clearest signals available to prevent harm. Health systems that systematically learn from these events can identify risks earlier and respond faster. Driving patient safety at scale will mean rethinking the way we respond to these early warnings. True progress happens through shared learning; when staff feel comfortable speaking up and sharing their experiences, healthcare organizations gain the insight needed to prevent a future occurrence.

Photo: designer491, Getty Images

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