INTRODUCTION:
patient safety incident reporting supports transparency, accountability and organisational learning. however, reporting remains suboptimal, with underreporting, delayed reporting and recurrent incidents. this abstract describes barriers and opportunities to strengthen incident reporting and the implications for patient safety culture in a hospital setting.

METHODS:
a qualitative case study was conducted using the root cause analysis framework from the veterans health administration national center for patient safety. in-depth interviews were undertaken with 16 informants from business office, inpatient and outpatient units, pharmacy, resident medical officers, nursing and quality risk management, supported by secondary hospital data. directed qualitative content analysis was performed in NVivo 15, informed by a multi-level reporting factors framework (individual, team, organisational, external) and a patient safety culture framework (open, just, reporting, learning).

RESULTS:
dominant barriers included knowledge and skills gaps, organisational constraints, hierarchical pressures, limited feedback and weaknesses in system design. underreporting persisted despite awareness of reporting importance, driven by fear of blame, unclear incident classification and burdensome procedures. delayed responses were linked to low urgency, high workload and insufficient monitoring. recurrent incidents were identified in medication errors, patient identification errors, equipment malfunction, scheduling failures and sporadic events, with human error as the primary root cause. patient safety culture showed partial progress: open culture was reflected in moral commitment to report, while just culture remained weak due to fear of punishment and social consequences. reporting culture was affected by emphasis on quantitative targets, and learning culture was limited by inconsistent documentation and follow-up. some units demonstrated resilience through team collaboration, supportive leadership and proactive mitigation.

CONCLUSIONS:
incident reporting foundations were present, but challenges remain in achieving timely, comprehensive and meaningful reporting. strengthening digital reporting functions, training, leadership support, and standardised feedback is critical to reduce underreporting, prevent recurrence and advance a mature patient safety culture.