• Harriette Van Spall, Alisha Kassam, and Travis T Tollefson.
• aDepartment of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario bDivision of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada cFacial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA.
• Curr Opin Otolaryngol Head Neck Surg. 2015 Aug 1; 23 (4): 292-6.

Purpose Of ReviewNear-miss investigations in high reliability organizations (HROs) aim to mitigate risk and improve system safety. Healthcare settings have a higher rate of near-misses and subsequent adverse events than most high-risk industries, but near-misses are not systematically reported or analyzed. In this review, we will describe the strategies for near-miss analysis that have facilitated a culture of safety and continuous quality improvement in HROs.Recent FindingsNear-miss analysis is routine and systematic in HROs such as aviation. Strategies implemented in aviation include the Commercial Aviation Safety Team, which undertakes systematic analyses of near-misses, so that findings can be incorporated into Standard Operating Procedures (SOPs). Other strategies resulting from incident analyses include Crew Resource Management (CRM) for enhanced communication, situational awareness training, adoption of checklists during operations, and built-in redundancy within systems.SummaryHealth care organizations should consider near-misses as opportunities for quality improvement. The systematic reporting and analysis of near-misses, commonplace in HROs, can be adapted to health care settings to prevent adverse events and improve clinical outcomes.

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