Guest blog post by Hanna Tiirinki, Chief Safety Investigator (Health and Social Care) – Safety Investigation Authority, Finland.
In Finland, the safety investigation of social and healthcare was initiated by SIAF (the Safety Investigation Authority Finland) in 2021. The branch for social and healthcare investigation is housed under the Safety Investigation Authority, alongside branches for aviation, railroad, maritime, and other accident investigations.
In Finland the establishment of a branch for health and social care safety investigation was preceded by extensive national and international preparatory work. As a part of this preparation, valuable advice and lessons were drawn from other international safety investigation organisations, particularly the Health Services Safety Investigations Body (HSSIB) in England, which is recognised as a pioneer in healthcare safety investigations. The experiences from HSSIB’s work at that time were encouraging.
Finland has closely followed the work of HSSIB and its investigations and has sought to contribute to building a strong international cooperation. In this regard, we can draw examples from other safety-critical sectors, such as the aviation (ICAO) and maritime (IMO) sectors. The lessons learned from the above-mentioned sectors – that have a long-standing track record of safety investigations – have demonstrated that internationally consistent methods and processes are a prerequisite for reliable investigations.
HSSIB has played a key role in bolstering the position of healthcare safety investigation organisations in various countries by systematically building cooperation with the WHO. In Finland, the safety investigation of social and healthcare services has been also recognised as a component of the WHO’s The Client and Patient Safety Strategy and Implementation Plan, to which Finland is committed.
It must be noted that national-level safety investigations inherently generate information that can promote patient safety across borders as problems and deficiencies in social and healthcare safety and adverse events, are often universal by nature.
Fostering cross-border learning from safety investigations
The model of social and healthcare safety investigations in Finland focuses on investigating adverse events that affects client and patient safety. This approach is comprehensive, involving various stakeholders from social and healthcare services, and emphasises transparency, accountability, and continuous improvement of safety. The SIAF investigates serious incidents, aiming at preventing future occurrences through detailed investigation reports and safety recommendations generated by safety investigations.
HSSIB has made significant strides in improving patient safety through its independent investigations. HSSIB’s work focuses on understanding the causes of incidents and sharing valuable lessons with healthcare systems. Its contribution to patient safety lies not just in identifying causes but in shaping safety culture across healthcare and promoting the philosophy of learning from mistakes.
HSSIB has significantly influenced Finland’s approach at the beginning of its national safety investigation journey – and I might dare to state that in the other countries as well – to social and healthcare safety investigation. By sharing its expertise on the structure and processes of independent investigations, HSSIB has helped all the client and patient safety community to refine its methods to investigate serious incidents reliably and effectively. The HSSIB’s model emphasises a non-punitive investigation approach, focusing on learning rather than blaming, which aligns well with Finland’s efforts to improve safety culture.
Internationally, HSSIB’s experience in conducting thorough and systemic investigations, and disseminating lessons learned is valuable. It can assist other countries in improving their healthcare safety systems. For example, HSSIB’s practice of involving families and patients in investigations offers a model for other nations seeking more human, transparent, and empathetic processes.
HSSIB has also excelled in bringing together safety investigators from various countries. The International Patient Safety Organisations Network (IPSON), assembled and chaired by HSSIB, is a highly significant international forum for discussing safety investigations. This network currently includes members from dozens of countries worldwide. For a small country like Finland, such professional international safety investigation networks are paramount.
Safety investigations for improving patient and client safety
We know, that behind each investigation is an adverse event and yes, people involved. Often, also from the second victim perspective, entire work communities, such as the ward staff, are impacted. Although the history of safety investigations extends to so-called hard safety-critical sectors (such as nuclear safety), there must always be room for humanity. Investigations have always been conducted from human to human, with the aim of ensuring that no one has to experience the same harm again.
The HSSIB has emphasised the importance of involving patients and families in the investigation process. While patient participation in healthcare is often discussed, concrete examples of this in practice are rare. This is an international challenge that requires leadership at a very practical level.
In Finland, we have learned from HSSIB’s systematic approach to involving patients and their families during investigations. This is an area where there is still much to learn, and best practices can be shared among countries.
Family involvement in social and healthcare safety investigation is relatively new compared to other safety-critical sectors, where communication with the next of kin is an established practice. However, involving families goes beyond just informing them. It’s active participation from families and loved ones.
Impact through recommendations
International cooperation has already borne fruit. We have formed a network where we regularly discuss safety investigations, methods, and share experiences between countries. HSSIB has been a leader in the use of diverse methods.
Discussions between HSSIB and Finland have especially focused on the follow-up of recommendations from safety investigations. We share a broader perspective with the international patient safety community that recommendations and their implementation are a key to improving safety in social and healthcare sectors.
From Finland’s perspective, it is notable that HSSIB has shown interest in learning from Finland’s model of recommendation follow-up, which spans ten years and involves a statutory obligation for oversight. International discussions on recommendation follow-up require experiences from different countries and a collaborative exploration of available methods. Sharing international experiences and exploring different follow-up methodologies enriches understanding and fosters stronger practices. HSSIB's dedication to fostering discussions around this topic helps countries identify impactful strategies to enhance social and healthcare safety.
A vision for a future cooperation
Developing safety investigations requires continuous sharing of information, peer learning, and discussions on how investigations can enhance quality and effectiveness. So far, the HSSIB's leadership as a promoter and driver of healthcare safety investigations has been extremely significant.
The goal of healthcare safety investigations should be to establish international practices, similar to those in aviation or maritime affairs which have been in place for many years. We also need an active dialogue with the WHO to standardise investigation methods, models, and best practices. Strong leadership and collaboration, which the HSSIB has fostered with other countries, remain essential. From Finland's perspective, the HSSIB's cooperation and support have been invaluable, particularly in establishing a new branch of investigation. I am confident that this collaboration will continue.
The future goal of international collaboration in the context of safety investigations is to strengthen partnerships between nations to establish uniform, effective investigation practices. This involves fostering networks where countries share knowledge, methods, and findings, leading to enhanced global safety standards. Promoting cross-border learning and aligning practices with organisations like the WHO is essential to standardise models and best practices. The aim is to build resilient systems that improve safety and quality worldwide, with leaders like HSSIB setting an example for continuous advancement and unity.
Going forward, we must also have the courage to consider whether healthcare safety investigations could be mandatory in the future, as they are in other safety-critical sectors. Certainly, this requires careful evaluation as well as international discussion and cooperation. However, this consideration is supported by the fact that standardising and unifying safety investigations can globally improve client and patient safety and ensure that all countries have access to the best possible practices and research methods.
International learning helps establish shared understanding of tools to improve client and patient safety, enabling closer cooperation between countries and strengthening safety networks worldwide. Such an approach leads us to systematic learning and stronger safety practices that are not limited to national borders but offer best practices and solutions to other countries as well. It should be mentioned as a conclusion that such an approach, which we have already been building in collaboration with HSSIB, strengthens systematic learning between countries.
In the end, it is important to remember that our shared goal is to make social and healthcare safer worldwide. For that, we need each other and leaders, like HSSIB.
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