This site has been optimized to work with modern browsers and does not fully support your version of Internet Explorer.

The Patient Safety Incident Response Framework (PSIRF)

The Patient Safety Incident Response Framework (PSIRF) sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents for the purpose of learning and improving patient safety. It will replace the current Serious Incident Framework (2015).

The framework  represents a significant shift in the way the NHS responds to patient safety incidents and is a major step towards establishing a safety management system across the NHS. It is a key part of the NHS patient safety strategy.

The PSIRF supports the development and maintenance of an effective patient safety incident response system that integrates four key aims:

  1. Compassionate engagement and involvement of those affected by patient safety incidents
  2. Application of a range of system-based approached to learning from patient safety incidents
  3. Considered and proportionate responses to patient safety incidents
  4. Supportive oversight focused on strengthening response system functioning and improvement

PSIRF document and supporting guidance

Oxford Patient Safety Collaborative involvement

We will work closely with our key stakeholders including local NHS Trusts, Integrated Care Systems and NHS Regional partners.  This group will seek to develop a bespoke support plan depending on local need and aligned to the national roll out.  Our support may also include facilitating of shared learning networks or collaboratives, specific training, and providing Quality Improvement coaching for implementation.

System safety

Our involvement in implementing the Patient Safety Incident Response Framework (PSIRF), sits within a broader programme of System Safety.  This has an overarching aim to create optimal conditions for patient safety improvement across our health systems.  Alongside PSIRF, this includes supporting the development of local Patient Safety Networks

Healthcare is a complex socio-technical system characterised by multiple interactions between various components, both human and technological.  It is complex because it is highly variable, uncertain, and dynamic.

A ‘work system’ consists of six broad elements: external environment, organisation, internal environment, tools and technology, tasks and person(s). People cannot be separated from the work system but sit at its centre; this emphasises that design should support – not replace or compensate for – people.

NHS England – SEIPS quick reference guide and work (version 1, August 2022)

To realise the vision of continuously improving patient safety, the NHS will build on two foundations: a patient safety culture and a patient safety system, across all settings of care.

The NHS Patient Safety Strategy – Safer culture, safer systems, safer patients (April 2019)