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Patient safety has emerged as one of the key risks facing advanced healthcare systems. Enormous efforts are being made in healthcare to manage and regulate these risks. One widespread approach involves collecting, analysing and learning from minor safety incidents and near-miss events, following the success of such systems in safety-critical industries such as aviation and chemical processing. This paper examines the nature and role of worker participation in safety incident-reporting systems. It argues that actively engaging with local personnel throughout the analysis and learning process (both drawing on their knowledge and influencing their practice) is a key reason for the success and regulatory efficacy of these reporting systems. The paper examines both the design of current patient safety reporting systems in healthcare, and the situated practices that support similar reporting systems in the airline industry. This analysis suggests that the concept of worker participation has not, at present, been heavily emphasized in patient safety reporting systems. The paper concludes by conceptualizing participation in a form that can be applied in healthcare, and examining how participation can support three key aims of risk regulation in healthcare: producing knowledge, creating accountability and supporting leadership. [ABSTRACT FROM AUTHOR]