Serious adverse event investigations in Australian healthcare: A national mixed‐methods study of senior healthcare safety and quality leaders

Serious adverse event (SAE) investigations are a central component of patient safety governance in healthcare, yet limited empirical evidence examines how these processes are experienced by senior healthcare leaders. Understanding leadership perspectives is critical, given their responsibility for commissioning, resourcing and governing investigations. The aim of this study was to examine senior healthcare leaders' perceptions of SAE investigation practices within Australian public healthcare networks. A mixed-methods design was employed, comprising a national cross-sectional survey followed by semi-structured interviews. Survey data were analyzed descriptively, and interview data were analyzed using inductive thematic analysis. Integration occurred through a sequential design and thematic synthesis of quantitative and qualitative findings. Findings indicated that SAE investigations are widely experienced as compliance-driven governance activities that impose substantial workload and resource burdens. Root Cause Analysis (RCA) remained the dominant investigation method despite concerns about its capacity to support sustained organizational learning. Leaders reported capability constraints, limited visibility of investigation costs and weak implementation of recommendations. Legislated protection was strongly supported in principle for promoting candor, yet its contribution to learning and transparency was experienced as variable. This study provides a leadership-level examination of SAE investigations and highlights tensions between accountability, learning and sustainability in contemporary healthcare systems.