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Near Miss Reporting and Organizational Learning in Health Care: Conceptual Framework Development Study.

Mohammed As'ad1

  • 1Dr Sulaiman Al Habib Medical Group, Corporate QPS, Headquarters, Al Awsat Valley S, Al Olaya, Riyadh, 12241, Saudi Arabia, 966 11525999.

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|April 22, 2026
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Summary

A new 3-level near miss framework (NM³) enhances patient safety by converting near miss data into actionable intelligence. This structured approach helps leaders distinguish real safety risks from reporting variations, improving healthcare quality.

Keywords:
acute carehospitalnear misspatient safetyquality improvementsafety culturestatistical process control

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Area of Science:

  • Healthcare Quality Improvement
  • Patient Safety Analytics
  • Risk Management

Background:

  • Current near miss reviews are inconsistent and distorted by patient volume and reporting culture.
  • Leaders struggle to differentiate genuine safety declines from increased reporting.
  • Existing systems lack the robustness to separate true safety risks from random variation.

Purpose of the Study:

  • To develop a 3-level near miss framework (NM³) for converting descriptive near miss data into decision-grade intelligence.
  • To provide a structured, evidence-based process for analyzing near miss events.
  • To enhance interpretation and governance of patient safety data.

Main Methods:

  • Developed the NM³ framework as a maturity model for acute inpatient settings.
  • Integrated standardized definitions, rate calculations, and statistical process control.
  • Incorporated severity weighting, learning metrics, and triangulation with harm events and culture measures.

Main Results:

  • Level 1 establishes baseline near miss rates and harm ratios using control charts.
  • Level 2 enables detection of local variation with unit-level charts and domain-specific denominators.
  • Level 3 generates a Near Miss Index, learning yields, and triangulates trends for comprehensive analysis.

Conclusions:

  • The NM³ framework offers a structured pathway to strengthen near miss analytics.
  • Organizations can improve interpretation of safety signals and prioritize high-consequence risks.
  • NM³ facilitates the integration of near miss reporting into organizational governance for enhanced patient safety.