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A variety of reporting systems are operating at different levels within healthcare systems across the world. Some operate primarily at the local level (risk management systems in hospitals), others at the regional or national level. Local systems are ideally used as part of an overall safety and quality improvement strategy but in practice may be dominated by managing claims and complaints. Many different clinical specialities, particularly anaesthesia, have established reporting systems to assist them in improving clinical practice. These systems are designed to provide information on specific clinical issues that can be shared within the professional group. The increasing attention paid to patient safety has led to the establishment of many new reporting and learning systems: most notably, in the UK, the Reporting and Learning System (RLS) established by the National Patient Safety Agency. Other national reporting systems include the wide‐ranging Veterans Affairs system in the US and the Australian Incident Monitoring System (AIMS).

The primary purpose of reporting systems is to communicate information about patient safety issues so that learning and improvement of systems and practice can occur. A secondary benefit of these systems is that we can use them to assess the scale of harm and identify trends.

There are inherent problems with all reporting systems in healthcare: most studies have found that reporting systems detect only 7–15% of adverse events²⁶ compared with other methods of detection such as case record review. Some of the common barriers to reporting include fear of embarrassment or punishment by oneself or others, fear of litigation, lack of feedback, and a belief that nothing will be done in response to reporting.