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Measuring Patient Safety: How Far Have We Come?

By Frank Federico | Friday, February 20, 2015

Is our health care system any safer today than it was back in 2000? In this post, IHI Executive Director Frank Federico, RPh, highlights five critical components for measuring patient safety. At IHI, Frank works in the areas of patient safety, and the application of reliability principles in health care. He is faculty for the IHI Patient Safety Executive Development Program and co-chaired a number of IHI Patient Safety Collaboratives.


It’s been nearly 15 years since the Institute of Medicine published the eye-opening report, To Err Is Human. In July 2014, the US Senate Subcommittee on Primary Health and Aging met with a panel of patient safety leaders to discuss the progress we have made on improving patient safety. Dr. Ashish Jha, a participant on the panel and a Harvard School of Public Health professor whose research focuses on improving quality and reducing costs, responded that “the unfortunate answer is ‘no’” when asked if patients are safer today — adding, “No one is getting it right consistently.”   

So, how do we know if patients are safer? And, what do we need to do to make our hospitals safer?

Measurement of safety has been difficult. A 2014 article by Charles Vincent and colleagues —“Safety Measurement and Monitoring in Healthcare: A Framework to Guide Clinical Teams and Healthcare Organisations in Maintaining Safety”  (BMJ Qual Saf. 2014;23:670-677) — highlights five questions that should be our focus:

  • Has patient care been safe in the past? We need to assess rates of past harm to patients, both physical and psychological. Methods include use of Trigger Tools; patient chart reviews; and measurement of infections, pressure ulcers, and other “defects” of care.
  • Are our clinical systems and processes reliable? Reliability has two key components when it comes to building safer systems: the reliability of the safety of critical processes and systems themselves, and the capacity of staff to reliably follow critical safety procedures. Standardization and simplification of processes are foundational design elements for more reliable, safer systems. Experience also tells us that a “one-size-fits-all” process design does not ensure reliability and safety, thus the approach of segmenting patients into groups enables care teams to design less complex processes that are safer and more reliably meet the needs of specific patient populations.
  • Is care safe today? Teams need access to data and the capacity to monitor safety on an hourly or daily basis. Vincent and colleagues refer to this as “sensitivity to operations.” How aware are staff of daily safety issues that may arise? Methods such as Patient Safety Leadership WalkRounds, daily huddles, and safety briefings and debriefings are helpful in identifying potential safety issues and opportunities for improvement. “Situational awareness” — that is, identifying problems before they happen so they may be prevented — is another crucial method for improving reliability and safety.
  • Will care be safe in the future? The ability to anticipate, and be prepared for, problems and threats to safety is key to preventing them. Case studies, safety culture assessments, and anticipating staffing levels and skills are all methods that help teams assess and prevent potential safety issues.
  • Are we responding and improving? This question speaks to the capacity of an organization to detect, analyze, integrate, respond, and improve from safety information. Aggregate analysis of safety incidents, claims, and complaints; feedback from clinicians; and identifying areas for improving safety, and tracking the rate of improvement over time, all help inform teams about opportunities to build safer, more reliable processes and systems.

The framework that Vincent describes provides one possible pathway to becoming a high-reliability organization. There are no shortcuts to becoming a high-reliability organization; leaders and clinicians need to recognize that this is a journey that takes time.  

Is 15 years too long to expect vastly safer care systems? Yes. Why have we not been more successful in making care safer? We’re looking for the quick fix rather than recognizing it’s a journey. Is anyone “getting it right consistently”? To ensure system-wide safety, organizations must implement safe practices in all units and all sites — read more in Carol Haraden’s blog on “The Elusive Coverage and Completeness.”

Do you think we have made progress in making health care safer? How do you know? Please share your thoughts in the comments section below.

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