A Framework for Safe, Reliable, and Effective Care

The Framework for Safe, Reliable, and Effective Care provides clarity and direction to health care organizations on the key strategic, clinical, and operational components involved in achieving safe and reliable operational excellence — a “system of safety,” not just a collection of stand-alone safety improvement projects.

Download White Paper


This white paper:

  • Describes the framework's two foundational domains — culture and the learning system — outlining what is involved with each and how they interact
  • Provides definitions and implementation strategies for nine interrelated components: leadership, psychological safety, accountability, teamwork and communication, negotiation, transparency, reliability, improvement and measurement, and continuous learning
  • Discusses engagement of patients and their families, the core of the framework — the engine that drives the focus of the work to create safe, reliable, and effective care

Health care organizations and systems may use the framework as a roadmap to guide them in applying the principles. The accompanying Diagnostic Tool helps organizations determine how well (or even if) they are pursuing the different components of the framework.

Although initially focused on the acute care setting, the framework has evolved to be more broadly applicable in any setting — in acute care, ambulatory care, home care, long-term care, and in the community.

How to Cite This Paper:

Frankel A, Haraden C, Federico F, Lenoci-Edwards J. A Framework for Safe, Reliable, and Effective Care. White Paper. Cambridge, MA: Institute for Healthcare Improvement and Safe & Reliable Healthcare; 2017. (Available on ihi.org)


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