Against this background of nearly 20 years of experience of research, development and improvement in patient safety, the role of incident and adverse event reporting, as well as the benefits that derive from it, is still a work in progress.This document has two main purposes: • to provide an up-to-date perspective on patient safety incident reporting and learning systems currently in place, including how to fill in existing gaps in these systems; • to provide practical guidance on the establishment and effective use of patient safety incident reporting and learning systems.