To support the development of a national approach to systems learning from sentinel events (SEs) in the Netherlands, this study evaluated how SEs are handled and leveraged for learning across eight academic hospitals. These hospitals use different approaches to analyze events, rarely use external experts in the process, and lack predetermined criteria for selecting recommendations for implementation. Given that five of eight included hospitals reported recurrence of similar SEs, the authors highlight the need for a transparent approach to assessing events and implementing recommendations successfully.