Patient safety leaders struggle with an impossible bottleneck: underreporting combined with an inability to triage what gets reported. Reporting barriers, inconsistent definitions, and manual review processes that can’t scale mean serious harm often goes uninvestigated; corrective actions lack validation, and dangerous patterns remain invisible. This guide walks through the barriers to both complete reporting and effective prioritization, and presents a structured framework for moving from activity-focused processes to evidence-based improvement. You’ll learn how to build the culture, infrastructure, and decision-support systems that help teams confidently answer the question “What should we focus on today?” What you’ll learn: Why underreporting persists despite invested reporting infrastructure, and how to reduce intake friction so staff actually report. How to scale from manual triage to structured prioritization that surfaces serious harm potential first. A four-capability framework for defining reportable harm, detecting patterns across events, and connecting corrective actions to measurable improvement. How mature patient safety programs track not just whether events were documented, but whether corrective actions actually reduced risk. How to build infrastructure that helps teams shift from reactive review to consistent, evidence-based action.