TITLE:
PSIRF-SELECT: A Structured Qualitative Deliberation and Documentation Framework for Selecting Proportionate Learning Responses under the Patient Safety Incident Response Framework in England
AUTHORS:
Adel Omar Bataweel
KEYWORDS:
Patient Safety, Patient Safety Incident Response Framework, PSIRF, National Health Service, NHS, England, Incident Response, Learning Response, Systems Thinking, Decision Support, Patient Involvement, Quality Improvement
JOURNAL NAME:
Health,
Vol.18 No.10,
October
23,
2026
ABSTRACT: Background: In England’s National Health Service (NHS), the Patient Safety Incident Response Framework (PSIRF) replaced prescriptive serious-incident thresholds with locally planned, considered and proportionate responses focused on learning and improvement. National guidance identifies important considerations, while local NHS organisations have developed decision meetings, flowcharts and matrices. However, implementation evidence and a 2025 report from the Health Services Safety Investigations Body indicate continuing uncertainty and variation in the practical selection of learning responses. Aim: To propose PSIRF-SELECT, a structured qualitative deliberation and documentation aid for use at the point where an NHS provider decides whether, why and how to undertake a learning response. Development: A targeted search and narrative synthesis of publicly accessible official guidance, peer-reviewed literature, international frameworks and local NHS tools was undertaken on 14 August 2026 and updated on 22 August 2026. The purpose was to identify existing decision support, examine whether the proposed operational gap was credible and derive candidate domains for the framework. This was not a systematic, scoping or rapid review. Candidate domains were compared with national requirements and relevant literature on systems thinking, involvement, outcome bias and investigation quality. Framework: SELECT comprises six domains: Specified requirements and immediate safety; Existing knowledge, evidence and improvement activity; Learning questions and potential; Engagement and equity; Context, complexity, capacity and coordination; and Type, transparent rationale and triggers for reconsideration. The word SELECT naturally contains two E positions: the first E concerns existing knowledge and improvement, while the second E concerns engagement and equity. The full domain names are used throughout to prevent ambiguity. Each domain is answered in words, not points. The output is a human-approved response with documented alternatives, uncertainties, engagement commitments and review triggers; no score or automatic recommendation is generated. Illustration and Evaluation: Three wholly synthetic cases demonstrate different outcomes: a patient safety incident investigation, a thematic review and no additional individual learning response beyond recording, engagement and monitored improvement. Co-design, feasibility testing and prospective multi-site validation are required before claims of effectiveness or routine adoption. Conclusion: PSIRF-SELECT offers a testable way to operationalise and make visible the reasoning already expected by PSIRF. Its contribution is integration, transparency and evaluability rather than replacement of existing guidance or judgement.