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.