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This article aims to examine the emergence of a system of multi‐level governance in Higher Education quality assurance during recent decades in Spain, as a particular case within the European Space of Higher Education. Although there is a well‐established multi‐level structure in the governance of this area at the European level, it is not very common to find countries having an internal multi‐level configuration. Most countries have allocated quality assurance at the national level, either concentrating responsibilities into a single agency or allowing competition between accreditation bodies. Thus, the Spanish scenario stands out as very singular model for the governance of Higher Education quality assurance, deserving attention to comprehend the intricacies of its coordination. Here we examine its development over the last two decades, and discuss three factors that have shaped inter‐agencies' relations: first, the sequence of agency creation and their accumulated expertise; second, the role of institutional structures for multi‐level coordination; and third, informal practices related to inter‐governmental relations, and the influence of country administrative traditions. From discussing this case, this article identifies three key lessons for understanding agency relations in multilevel governance environments: first, path dependence significantly impacts‐regulatory interactions over time; second, the Administrative culture, particularly centralist traditions, considerably shapes relationships in multi‐level bodies; and, third, the coordination models in regulatory networks (hierarchical, network or market‐based) tend to reflect those underlying political dynamics. [ABSTRACT FROM AUTHOR]

Independent police oversight bodies are advocated by human rights organisations to be the most credible and effective solution to address the misbehaviors and systemic malfunction. They have emerged in parallel with independent regulatory agencies in various economic sectors, thus signalling a new trend in governance interpreted as the rise of a 'fourth power.' Still, comparative knowledge is scarce about the nature of delegation of power to police oversight agencies (POAs) and their actions. By analyzing 25 POAs in 20 countries, this article seeks to precisely describe their features in Europe and Quebec (Canada): the timeline of their birth, the scope of delegation (remit, formal independence, powers, resources), and the variations in how they execute their mandate. We unveil a profound heterogeneity across countries. In terms of national patterns, the main divide is between specialised (police only, limited formal independence, more abundant resources) and non-specialised (all public administrations, strong formal independence, limited resources) agencies. The latter tend to act as a public fire alarm to compensate for their lack of resources. Our mapping also contrasts European countries' oversight mechanisms, which rely on professional agencies that are mostly established at the national or state/regional level, with local civilian oversight boards in the US. And, while our results confirm that the 1990s marked a watershed, they question the notion that agencification in the police sector has been a vector for revolution in its governance, since no POA incorporates all the traits required for them to be the fourth power just yet. [ABSTRACT FROM AUTHOR]

This paper opens up the black box of agencies' accountability relationships and zooms in on their top managers and the perceptions of accountability thereof. So far, very few studies have examined how agency managers perceive and experience attempts to control the public sector organizations that they manage. The paper seeks to address this gap through a focus on "felt" accountability, denoting (1) a manager's (more or less high) expectation to have to explain substantive decisions to a parent department perceived, (2) to have (more or less) the expertise, and (3) to be (more or less) in a legitimate position to assess those decisions. We empirically explore in two steps (using quantitative and qualitative data) agencies' felt accountability to the parent department in Switzerland, which presents a puzzling case of relatively low accountability according to a survey of agency managers in seven established democracies (Australia, Denmark, the Netherlands, Norway, Sweden, Switzerland, and the United Kingdom). Our findings point to the differences between regulatory and non-regulatory agencies and show that the former's perception of being weakly accountable largely stems from the passive attitude of the parent ministry as official accountability forum. Agency managers interpret this attitude as a manifestation of respect for the agencies' independence, but also as a consequence of the forum's lack of time and expertise. In some cases, the parent ministry is not even considered to be the relevant accountability forum, suggesting that this accountability relationship is just one facet of the accountability regime in which agencies are embedded. [ABSTRACT FROM AUTHOR]

Recently, an unexpected public actor has joined climate activists' forces: central banks increasingly care about and act on climate change. Their (potential) contribution to the climate-neutral economy is immense, as they possess vast institutional resources to influence investment in the economy. Central banks' advocacy is puzzling, as they put their legitimacy at risk by stepping outside their mandates and area of expertise. To explore this puzzle, I study why and how climate change came on the agenda of the Dutch central bank, one of the first movers among central banks. By opening the black box of organizational politics within central banks and building on unique interview data, I show how the policy shift of the Dutch central bank can be traced back to a small group of policy-seeking staff. This process-tracing case study contributes to our understanding of transformative change in climate policy in particular and public policy more generally. [ABSTRACT FROM AUTHOR]

This manuscript analyses the parliamentary scrutiny of the presidential appointments to the direction of independent Brazilian Regulatory Agencies from an in-depth case study of the heads of the Brazilian Health Regulatory Agency—ANVISA, between 1999 and 2021. In Brazil, the Senate has the final decision on these appointments, exercising a dual function: parliamentary control over presidential patronage and selecting future heads of agencies. The objective of this article was to explain how the parliament exercises these functions and interferes in the appointment process. The results indicate that, although the formal process of parliamentary scrutiny seems like a game of marked cards, where it is already known in advance that the result will be approval, the Parliament plays an anticipatory role of presidential decisions, interfering in the timing of appointments and the possibility of influence over the choice of nominees. [ABSTRACT FROM AUTHOR]

The increased authority delegated to independent agencies raises questions about the conditions of politically accountable governance, and specifically parliament's role as a representative institution. Focusing on committee hearings as an accountability mechanism, we ask: How can a parliament employ hearings to ensure that the ends pursued by agencies have a democratic foundation? We propose a model of "mutual attunement" where accountability relations presuppose a process of working-out shared understandings of the ends, means and circumstances of policy needs. We test our argument through a case study assessing the interaction between the European Parliament's Committee on Economic & Monetary Affairs and the European Securities and Markets Authority. Theoretically, we contribute to discussions on agency accountability and European governance, while providing a novel conceptual model and the first analysis of its kind. [ABSTRACT FROM AUTHOR]

Some economists have suggested that fiscal councils, rather than the government, should manage public debt. What are the democratic credentials of these institutions? This article answers this question from the point of view of republican democratic theory. In doing so, it develops a critique of Pettit's strategy of depoliticization as a proper way to preserve the nondomination of citizens. Borrowing from the literature on deficit bias, the article argues instead that citizens and parliaments should be given the informational resources needed to keep the executive under sufficient republican control. This suggests that fiscal councils should not manage public debt but rather be used as tools to reduce the information asymmetry between executives and parliaments that drives deficit bias and that results in public powers being used arbitrarily. [ABSTRACT FROM AUTHOR]

Abstract This paper addresses the effects of the new general law on independent agencies in Brazil. This regulatory reform sought to increase transparency and accountability, strengthen ex-ante evaluation, and improve decision-making. The research objective was to evaluate the possible organizational and institutional consequences of these changes. The study compared data collected from key actors in the 11 agencies referring to the period before the law with the regulatory scenario one year after the law was enacted. The results allow an unprecedented panoramic view of the agencies’ instruments under the inspiration of better regulation, and the new scenario can positively impact these structures’ credibility and trust. The study indicates an advance in the Brazilian regulatory governance model and opens space for future research.

The paper deals with the specific features of higher education quality assurance in France based on the development of partnership between government, universities and independent agencies. The information about the two independent agencies providing assessment ofeducation quality – AERES and CTI is presented. The results of comparative analysis of Russian and French quality assurance systems in education are discussed with the aim to study the possibility of foreign experience transformation into the practice of Russian universities.

This study draws on the organizational publicness scholarship to propose that although both executive departments and independent agencies collectively are part of the federal bureaucracy, executive departments have higher organizational publicness that affects their organizational processes and employee's job satisfaction. Analyses of federal employee viewpoint survey indicate that executive departments directly affect job satisfaction and moderate work unit quality, supervisor quality, and leadership quality's effect on job satisfaction. Public organizations' effects on job satisfaction are more nuanced than the existing scholarship suggests. Where constitutional norms allow, public organizations should promote the independent powers of work units' leaders. [ABSTRACT FROM AUTHOR]

Regulatory governance requires multiple, complex channels of accountability, especially when agencies are located at the conjunction of judicial, executive, and legislative powers. In this paper, I evaluate appointments to independent regulators in India, focusing on eight key bodies. A study of how they staff and manage their appointments, in the Indian context, demonstrates a significant reliance on judicial review as a mechanism of control, to the near exclusion of any other method of accountability. A limited effort to define certain regulators as judicial bodies, based on their decision-making functions, has enabled some accountability, but in other cases, judges struggle to find ways to constrain executive power outside the confines of judicial -activity. As with other states that have active courts engaged in monitoring regulatory -activity, the Indian case, as this paper argues, demonstrates that accountability is better achieved by supplementing judicial review with participatory governance and legislative frameworks. [ABSTRACT FROM AUTHOR]

This paper addresses the effects of the new general law on independent agencies in Brazil. This regulatory reform sought to increase transparency and accountability, strengthen ex-ante evaluation, and improve decision-making. The research objective was to evaluate the possible organizational and institutional consequences of these changes. The study compared data collected from key actors in the 11 agencies referring to the period before the law with the regulatory scenario one year after the law was enacted. The results allow an unprecedented panoramic view of the agencies' instruments under the inspiration of better regulation, and the new scenario can positively impact these structures' credibility and trust. The study indicates an advance in the Brazilian regulatory governance model and opens space for future research. [ABSTRACT FROM AUTHOR]

Background: Understanding the causes of patient safety incidents is essential for improving patient safety; therefore, reporting and analysis of these incidents is a key imperative. Despite its implemention more than 15 years ago, the institutionalization of incident reporting in Indonesian hospitals is far from satisfactory. The aim of this study was to analyze the factors responsible for under-reporting of patient safety incidents in Indonesian public hospitals from the perspectives of leaders of hospitals, government departments, and independent institutions. Methods: A qualitative research methodology was adopted for this study using semi-structured interviews of key informants. 25 participants working at nine organizations (government departments, independent institutions, and public hospitals) were interviewed. The interview transcripts were analyzed using a deductive analytic approach. Nvivo 10 was used to for data processing prior to thematic analysis. Results: The key factors contributing to the under-reporting of patient safety incidents were categorized as hospital related and nonhospital related (government or independent agency). The hospital-related factors were: lack of understanding, knowledge, and responsibility for reporting; lack of leadership and institutional culture of reporting incidents; perception of reporting as an additional burden. The nonhospital-related factors were: lack of feedback and training; lack of confidentiality mechanisms in the system; absence of policy safeguards to prevent any punitive measures against the reporting hospital; lack of leadership. Conclusion: Our study identified factors contributing to the under-reporting of patient safety incidents in Indonesia. The lack of government support and absence of political will to improve patient safety incident reporting appear to be the root causes of under-reporting. Our findings call for concerted efforts involving government, independent agencies, hospitals, and other stakeholders for instituting reforms in the patient safety incident reporting system.

This paper is dedicated to the functioning and importance of independent agencies versus balance in the proper functioning of the legal system of the state. Independent institutions are the key element of a functioning democracy. Together with the legislature, the executive and the judiciary they enable a developed system of maintaining balance, increasing accountability and mitigating undue political influence. The challenges that accompany Kosovo's transitional democracy continue to hamper the development of institutions ranging from persistent resource shortages to political interference. The Government and Assembly of Kosovo should lead by example and publicly demonstrate their unwavering support for independent institutions. They must respect their full independence guaranteed by the Constitution and the law. The reasonable legal basis provides reasons for encouragement along with the strong institutional structure that most of the institutions analyzed possess. Otherwise, if current practices continue, then security institutions will have no motive to cooperate with independent institutions.

Combining performance data from the Bush Administration's Program Assessment Rating Tool (PART) initiative with measures of organizational independence, I examine whether insulated and plural leadership structures are consequential for the outcomes of the federal programs administered by them. Using regression modeling and controlling for program type, I find that embedding programs in independent agencies is positively and significantly related to ratings of program performance. The effects of independent commissions appear mediated in these models by their positive association with the PART scores given to certain program types, notably research programs. These results are problematic for any global attribution of greater effectiveness to executive agencies under single-headed control and closer presidential direction.

Background: Understanding the causes of patient safety incidents is essential for improving patient safety; therefore, reporting and analysis of these incidents is a key imperative. Despite its implemention more than 15 years ago, the institutionalization of incident reporting in Indonesian hospitals is far from satisfactory. The aim of this study was to analyze the factors responsible for under-reporting of patient safety incidents in Indonesian public hospitals from the perspectives of leaders of hospitals, government departments, and independent institutions. Methods: A qualitative research methodology was adopted for this study using semi-structured interviews of key informants. 25 participants working at nine organizations (government departments, independent institutions, and public hospitals) were interviewed. The interview transcripts were analyzed using a deductive analytic approach. Nvivo 10 was used to for data processing prior to thematic analysis. Results: The key factors contributing to the under-reporting of patient safety incidents were categorized as hospital related and nonhospital related (government or independent agency). The hospital-related factors were: lack of understanding, knowledge, and responsibility for reporting; lack of leadership and institutional culture of reporting incidents; perception of reporting as an additional burden. The nonhospital-related factors were: lack of feedback and training; lack of confidentiality mechanisms in the system; absence of policy safeguards to prevent any punitive measures against the reporting hospital; lack of leadership. Conclusion: Our study identified factors contributing to the under-reporting of patient safety incidents in Indonesia. The lack of government support and absence of political will to improve patient safety incident reporting appear to be the root causes of under-reporting. Our findings call for concerted efforts involving government, independent agencies, hospitals, and other stakeholders for instituting reforms in the patient safety incident reporting system.

Background: Understanding the causes of patient safety incidents is essential for improving patient safety; therefore, reporting and analysis of these incidents is a key imperative. Despite its implemention more than 15 years ago, the institutionalization of incident reporting in Indonesian hospitals is far from satisfactory. The aim of this study was to analyze the factors responsible for under-reporting of patient safety incidents in Indonesian public hospitals from the perspectives of leaders of hospitals, government departments, and independent institutions. Methods: A qualitative research methodology was adopted for this study using semi-structured interviews of key informants. 25 participants working at nine organizations (government departments, independent institutions, and public hospitals) were interviewed. The interview transcripts were analyzed using a deductive analytic approach. Nvivo 10 was used to for data processing prior to thematic analysis. Results: The key factors contributing to the under-reporting of patient safety incidents were categorized as hospital related and nonhospital related (government or independent agency). The hospital-related factors were: lack of understanding, knowledge, and responsibility for reporting; lack of leadership and institutional culture of reporting incidents; perception of reporting as an additional burden. The nonhospital-related factors were: lack of feedback and training; lack of confidentiality mechanisms in the system; absence of policy safeguards to prevent any punitive measures against the reporting hospital; lack of leadership. Conclusion: Our study identified factors contributing to the under-reporting of patient safety incidents in Indonesia. The lack of government support and absence of political will to improve patient safety incident reporting appear to be the root causes of under-reporting. Our findings call for concerted efforts involving government, independent agencies, hospitals, and other stakeholders for instituting reforms in the patient safety incident reporting system.

Despite that independent agencies are typically justified in terms of technical efficiency, they inevitably have to make political judgments. How can political reasoning be legitimate in such institutions? This paper starts by investigating the merits of two prominent models. The "avoidance model" asks agency reasoning to stick to empirical facts and as far as possible stay clear of political values. By contrast, the "specification model" recognizes the need for constructive normative work, but confines it to the refinement of given statutes. This paper challenges both models and defends a third alternative. The "public reason model" requires agencies to ground their value judgments in a publicly accessible framework of reasoning, which is here interpreted as their overarching mandate. The paper argues that agency mandates should be conceived as distinct domains of reasoning, and it delineates three institutional virtues that enable agencies to track this domain. [ABSTRACT FROM AUTHOR]

This paper is dedicated to the functioning and importance of independent agencies versus balance in the proper functioning of the legal system of the state. Independent institutions are the key element of a functioning democracy. Together with the legislature, the executive and the judiciary they enable a developed system of maintaining balance, increasing accountability and mitigating undue political influence. The challenges that accompany Kosovo's transitional democracy continue to hamper the development of institutions ranging from persistent resource shortages to political interference. The Government and Assembly of Kosovo should lead by example and publicly demonstrate their unwavering support for independent institutions. They must respect their full independence guaranteed by the Constitution and the law. The reasonable legal basis provides reasons for encouragement along with the strong institutional structure that most of the institutions analyzed possess. Otherwise, if current practices continue, then security institutions will have no motive to cooperate with independent institutions. [ABSTRACT FROM AUTHOR]

It is generally assumed that independent agencies reflect the Congress' willingness to deal with two different sources of risk that complement each other: political uncertainty regarding the policy implemented, and technical uncertainty regarding the outcome that would be achieved with that policy. This paper claims that such complementariness is true only when the Congress is expecting to capture the benefits of a sound technical decision. If this is not the case, for example when there is a large possibility of a political turnover in the near future, institutional design should follow a dynamic of entrenchment. Here politics and expertise substitute each other, thus reducing the optimal choice of agency independence. This paper illustrates these ideas by comparing the two waves of institutional reforms that occurred in Chile in the 1920's and the 1980's. The variance in the level of insulation achieved by each process responds to a key political difference: the first one was conducted through a democratic consensus that was meant to last several decades, whereas the second one was conducted during an authoritarian regime aware that its tenure in power was coming to an end. [ABSTRACT FROM AUTHOR]

Copyright of Esferas is the property of Esferas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The political problems of democratic legitimacy related to the construction of the European Union have mutated deeply during the crisis. The survival of the Eurozone has exacted a high toll on democratic principles. National representative democracy has been weakened due to the imperatives of economic integration. The technocratic elements of European integration (independent agencies, binding rules on economic matters) have expanded dramatically in scope. In the past, the technocratic dimension was circumscribed to efficiency-enhancing policies; during the crisis, it has been extended to issues with clear distributional consequences (such as the burden of adjustment between debtor and creditor countries). The resulting paradox is that in a time of growing 'politicization' of European affairs, the technocratic bias of the European Union has 'depoliticized' economic issues. This article reviews the recent debates about the tension between technocracy and democracy in the context of European supranational integration. [ABSTRACT FROM AUTHOR]

The Spanish Act 6/2013 created the Fiscal Responsibility Independent Agency (AIReF) to implement European law which obliges member States to create Fiscal Responsibility Independent Authorities for supervising compliance of European rules for budgetary stability and financial sustainability. This independent authority complies, in general, with the European and international standards of independence. But the own AIReF has criticized Spanish government for obstructing access to necessary information for complying with its mandate. In the absence of sufficient reactive powers, which the legislator could have provided for AIReF, European authorities could start a sanction procedure against Spain for breaching European law that obliges independence of the fiscal responsibility national authorities. [ABSTRACT FROM AUTHOR]

Copyright of Revista Digital de Derecho Administrativo is the property of Universidad Externado de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The foundation of the CNMC by Spanish Act 3/2013 was preceded by a warning from the European institutions about the possible opening to Spain of proceedings for infringement of European law. European Commission argued unlawfulness of the new governmental powers that should be attributed to this regulator and challenged the breach of the pre-existing regulators independence caused by their early removal. This paper analyzes arguments which justified economic regulators merger on a single CNMC whose independence is mandatory by European law. In particular, it explores the impact on the status of independence of the national regulators laid down by the European law and, especially, by the European ruling which has recently confirmed that early removal ex lege of the fixed term of regulators by foundation of a new regulator implies a breach of their independence and infringes European law. [ABSTRACT FROM AUTHOR]

In this Academic Survey some Constitutional Law Professors answer questions about legal control of power, as central feature of the Constitutional State, and about the problems that nowadays face our Constitutional State in order to guarantee this legal control and that refers to political parties system, political parties regulation, and action of political parties. [ABSTRACT FROM AUTHOR]

The recent reform of the economic Constitution invites to analyze the current Politics-Economy relationship and, in particular, the evolution of the widespread tendency opened several decades ago for independent decision making on the economy --and, also, for the guarantee of fundamental rights--through the creation of independent agencies. After the initial success of this model, generalizing it and strengthening it, have occurred in recent times decisions of public authorities which demonstrate, even of contradictory form and, perhaps, cyclical, the crisis and breach of the paradigm of the regulator independence. This paper aims to illustrate the evolution suffered by independent authorities and highlights the relevant examples that demonstrate the risk of breaching the regulators independence. [ABSTRACT FROM AUTHOR]

What might account for the varying degrees of autonomy granted to public agencies? One broad range of answers is provided by a structural-instrumental perspective on organizations, which assumes that the assignment of autonomy is a response to structural features of organizing on the one hand and to task considerations on the other. Taking the case of Hong Kong, data from a survey of chief executives of 111 government agencies on perceptions of autonomy are analyzed to explore a series of propositions concerning the relationships between structure, task, and perceived autonomy. The method of ordinary least square regression is used to analyze the data. Overall, the findings show that variables describing key features of structure and task do help to explain degrees of autonomy. However, two propositions drawn from rational choice theory concerning task-related variables are not confirmed: public service delivery organizations are under tighter, not looser control, whereas regulatory agencies show no tendency toward autonomy. Interpretation of the findings points to significant features of Hong Kong’s constitutional and political history which highlight the importance of contextualization. [ABSTRACT FROM PUBLISHER]

Postal regulation has changed dramatically within the European Union over the past decade. This article theorizes and empirically investigates domestic conditions which have shaped the institutional realization of regulatory reform. It seeks to explore how the commitment-control problem, inherent to any delegated setting, has been resolved in different countries. In which ways have national governments delegated regulatory powers to independent agencies and how do these operate in practice? Combining delegation theory and the variety of capitalism approach, expectations for three distinct varieties of delegation are formulated which are then exposed to empirical scrutiny studying the UK, Germany and France. The typology accounts for cross-country variance in de facto agency independence and regulatory practice, but contradicts patterns of formal delegation. In view of a striking discrepancy between formal arrangements and actual practice, the author makes a strong argument in favour of studying the dynamic and longitudinal effects of interaction. [ABSTRACT FROM AUTHOR]

Over the course of the last two decades there has been a recurring theme among proponents of the National Park Service mission that politics has undermined the day-to-day goals of the Service. With the increased politization of the Park Service, two recent proposals have called for removal of the NPS from the Department of the Interior and call for it to become an independent body along the lines of other government entities such as the Smithsonian Institution. This article reviews these proposals and suggests that in the long run removal from the Department of the Interior will not solve the problems of the NPS and may well accelerate them. [ABSTRACT FROM AUTHOR]

The word independent in the United States (US) context is most properly used in connection with the independent regulatory commissions. Those commissions are not independent of Congressional control. Both the commissions and the agencies of the regular cabinet departments live in a regime of statutory duties under which Congressional statutes not presidential policies control much of their behavior. Both are subject to judicial review. Commissions basically are independent in the sense that they are usually not subject to the complete control by commissioners of one political party. They are somewhat independent of the President in that no single President has appointed all the commissioners of a particular commission and commissioners may only be dismissed by the President for cause. American experience suggests that European Union (EU) independent agencies will create severe problems of co-ordination, legitimacy and control. These problems are not alleviated by the claim that EU agencies will have purely informational roles because information is a key element in policy-making and policy controversy. [ABSTRACT FROM AUTHOR]

Background: Understanding the causes of patient safety incidents is essential for improving patient safety; therefore, reporting and analysis of these incidents is a key imperative. Despite its implemention more than 15 years ago, the institutionalization of incident reporting in Indonesian hospitals is far from satisfactory. The aim of this study was to analyze the factors responsible for under-reporting of patient safety incidents in Indonesian public hospitals from the perspectives of leaders of hospitals, government departments, and independent institutions. Methods: A qualitative research methodology was adopted for this study using semi-structured interviews of key informants. 25 participants working at nine organizations (government departments, independent institutions, and public hospitals) were interviewed. The interview transcripts were analyzed using a deductive analytic approach. Nvivo 10 was used to for data processing prior to thematic analysis. Results: The key factors contributing to the under-reporting of patient safety incidents were categorized as hospital related and nonhospital related (government or independent agency). The hospital-related factors were: lack of understanding, knowledge, and responsibility for reporting; lack of leadership and institutional culture of reporting incidents; perception of reporting as an additional burden. The nonhospital-related factors were: lack of feedback and training; lack of confidentiality mechanisms in the system; absence of policy safeguards to prevent any punitive measures against the reporting hospital; lack of leadership. Conclusion: Our study identified factors contributing to the under-reporting of patient safety incidents in Indonesia. The lack of government support and absence of political will to improve patient safety incident reporting appear to be the root causes of under-reporting. Our findings call for concerted efforts involving government, independent agencies, hospitals, and other stakeholders for instituting reforms in the patient safety incident reporting system., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Dhamanti I et al.)