Pre-intervention Phase
The two existing, topic-specific near-miss reporting systems and adverse event/incident reporting systems were critically analysed during the pre-intervention phase. Consultative meetings, key informant interviews (KIIs), and focus group discussions (FGDs) were conducted by the principal investigator (PI) using semi-structured guides until theoretical saturation was achieved (9). Study tools were validated through input from officials from DHQS, and pre-testing was undertaken with FHB and NBTS staff. These guides were designed to extract information from purposively selected participants about their perceptions and opinions about near-misses, near-miss reporting, key barriers, and recommendations for developing and implementing a national reporting system.
An initial consultative meeting was held with a purposively selected sample of 20 representatives from prominent professional colleges and academic centres, e.g. Sri Lanka College of Surgeons, Sri Lanka College of Obstetricians and Gynaecologists, Sri Lanka College of Anaesthesiologists, Sri Lanka College of Physicians, Sri Lanka College of Paediatricians, University of Colombo, etc.
These representatives, who were specialist medical officers in several specialties, were from different hospitals in different geographical areas in the country. Since they were experienced senior specialists, they possessed a clear understanding and knowledge about the near-misses that occur in their units.
KIIs were held with the present and two previous Directors of the DHQS, the National Programme Manager of the Maternal Morbidity/Mortality Surveillance Programme of the FHB, the Head of the Hemovigilance Unit – NBTS, and three purposively selected heads of the institutions and two Special Grade Nursing Officers (SGNO) (equivalent Chief Nursing Officers) of DGH Avissawella. FGDs were held with eight Consultants (Group 1) and 14 Nursing Sisters and Unit in-charge Nursing Officers (Group 2) of DGH Avissawella.