How can the Greece National Strategy for Quality of Care and Patient Safety be taken forward?

Countries worldwide continue working towards the achievement of the World Health Organization (WHO)’s 2030 Patient Safety Global Action Plan, which underscores the importance of having a national strategy for quality of care and patient safety [1]. A national quality strategy provides a framework for patient safety and includes several benefits as noted by several scholars [2, 3]. For example, it enhances alignment of fragmented efforts through the establishment of a common vision, priorities, role clarity, and standardization. It enables performance monitoring, targeted improvement, and influences direction for resource use related to quality and safety initiatives. Additionally, it aids with the alignment of global priorities to the local context. However, a top-down approach and exclusion of implementers at the conceptualization stage of national strategies and policies remain common [4]. A recent study by Fonseca et al. [5] illustrates an evidence-informed, co-creation approach in developing Greece’s first National Strategy for Quality of Care and Patient Safety. This approach is noted to be more collaborative in building a sustainable patient safety posture. A three-phase approach was followed (assessment, co-creation, and validation), with intense investment in the assessment phase, which included a scoping review of global literature, a nationwide survey, and semi-structured interviews, and seven regional co-creation workshops, engaging participants across all Greek health regions to identify priorities for the strategy [5]. Over 750 stakeholders contributed, including policymakers, clinicians, hospital managers, patient advocates, and academics. A key insight from this study illustrated the possibility of inclusive prioritization in collaboration with frontline policy implementers at the conceptualization stage of developing a national strategy. This study serves as a useful framework for benchmarking other nations that seek to develop their own strategy for quality of care and patient safety. The lessons that emerged from this work include the use of robust evidence to inform strategy and co-production with frontline policy implementers and the public to enhance feasibility and gain buy-in and ownership among diverse stakeholders. Collaboratively, stakeholders identified their top priorities for the strategy, including focus on stronger governance, creation of a national safety reporting system, better workforce training, digital tools, and greater patient involvement. This demonstrates the power of inclusion of diverse stakeholders in prioritizing the key areas that matter to everyone interested in the strategy. In this paper, Greece achieved an important milestone that many countries continue struggling to achieve. The WHO Global Patient Safety report indicates that only around one third of countries have developed national action plans and programs for patient safety [6]. The global burden remains substantial: one in 20 patients is exposed to preventable harm, 12% of hospitalizations result in serious adverse events, and poor-quality care causes over five million deaths annually worldwide [5]. Challenges such as limited monitoring, weak safety culture, workforce shortages, and low patient engagement, which were unveiled by the Greek situational analysis are not uncommon experiences in other health systems. The needs assessment revealed that ∼60% of respondents rated national quality governance as ineffective, over 70% described patient safety systems as underdeveloped, and fear of blame was cited by 49% of respondents as the leading deterrent to incident reporting [5]. These findings resonate with global evidence on the systemic barriers to safety improvement. Nevertheless, the identification of these weaknesses through a structured, participatory process is a critical milestone, as it provides a foundation for targeted and context-specific action. Meanwhile, having a national strategy is an applauded milestone, but it is critical for the implementers to build on the ongoing momentum and translate the strategy into measurable improvements. The strategy itself includes a dedicated monitoring framework with tracer indicators linked to its three strategic directions, alongside plans for a National Quality Dashboard to enable real-time performance tracking at system and facility levels [5]. The co-creation approach, while strengthening ownership and relevance, would benefit from even earlier involvement of patients and frontline professionals in agenda-setting, a limitation acknowledged by the authors themselves. Future research should examine whether co-creation processes are associated with stronger uptake of strategic actions, sustained governance arrangements, and measurable improvements in patient safety outcomes. Longitudinal evaluation across different health system contexts would provide valuable insights into the mechanisms through which participatory design enhances long-term system change. The transferability of the Greek model to other settings should be considered in light of local cultural values, health system structures, and available resources, emphasizing adaptation rather than replication. A three-phase approach (situation analysis, co-creation, and validation) presented by Fonseca et al. is a straightforward approach that offers a replicable yet adaptable framework for other countries that intend to co-create quality and safety strategies with the implementers responsible for their success. Beyond the technical output, the Greek experience demonstrates that inclusive, evidence-informed processes can strengthen legitimacy, ownership, and the institutional foundations required for sustainable implementation. Sustained political commitment, continued monitoring, and rigorous evaluation will be essential to ensure this strategy delivers on its ambitious vision. Immaculate Sabelile Tenza (Conceptualisation, Writing—Original Draft, Writing—Review & Editing) Hager Saheh (Conceptualisation, Writing—Review & Editing), Richard G. Greenhill (Conceptualisation, Writing—Review & Editing) None declared. None declared.