Measurement is fundamental to advancing improvement. However, there is not presently a broadly agreed upon set of metrics to understand the current state of patient safety. There are critical measurement gaps in key settings, such as ambulatory care, and the current measurement methodology fails to detect all instances of errors and harms, and is often reactive rather than proactive.
Over the last 15 years, safety measurement has become routine in many areas of health care. However, unlike with other aspects of quality, there is not presently consensus on a set of metrics to understand the current state of patient safety. There are critical measurement gaps in measuring safety in key emerging settings such as ambulatory care and in measuring the use of low-value care. The current measurement methodology, which often relies on retrospective surveillance via claims data or chart reviews, fails to detect all instances of errors and harms or the level of safety in the health care we deliver.
Poorly devised or under-utilized metrics carry the potential for unintended negative consequences. For example, one particularly common measure – “total adverse events” – may be too heterogeneous to provide meaningful data for improvement, yet it is often used as a primary metric for assessing patient safety. Current measures predominantly focus on inpatient safety rather than safety across the entire continuum and are retrospective and reactive, not allowing for the identification and measurement of risks and hazards before an adverse event occurs. They may also fail to adequately represent what is meaningful to patients (including emotional harm and disrespectful behavior).
The safety field needs to develop a set of meaningful measures that accurately assess the safety of patient care and focus on improvements of care across the continuum. At this meeting, we will utilize a comprehensive view of harm to inform the creation of recommendations for a framework to guide the development of more effective measures and collection strategies, and to help ensure validity of effective measures for safety, error, and harm through the lens of various stakeholders, including the patient. We will focus on cross-continuum measures that support the safety of patients and the healthcare workforce with the ultimate aim of developing design principles and recommendations for a framework of actionable areas of measurement focused on learning and improvement that can be applied in high, medium, and low-income countries
KEY QUESTIONS
PARTICIPANT PROFILE
This program will bring together around 50 participants, including global healthcare leaders, researchers and design thinkers, patients, providers, and experts in measurement, quality improvement, operations, and informatics from measurement and patient safety-focused organizations around the globe.
PROGRAM FORMAT
This program will be highly participatory, with a strong focus on synthesizing experience from different settings. The program will combine presentations and panel discussions with group conversations and participant-led group work to develop an actionable, cross-continuum framework for safety measurement.
EXPECTED OUTCOME AND IMPACT
This program will seek to create:
Issue One (Friday, September 6, 2019)
Issue Two (Sunday, September 8, 2019)
Issue Three (Tuesday, September 10, 2019)
Adler, Lee, Impact of Inpatient Harms on Hospital Finances and Patient Clinical Outcomes, Journal of Patient Safety, 2018 June, 14(2): 67-73.
Bates, David W, and Hardeep Singh, Two Decades Since To Err Is Human: An Assessment Of Progress And Emerging Priorities In Patient Safety, Health Affairs, November, 2018.
Classen, David, and others, An Electronic Health Record–Based Real-Time Analytics Program For Patient Safety Surveillance And Improvement, Health Affairs 37, Nr. 11, 2018.
Improving Diagnostic Quality and Safety, National Quality Forum, Final Report 19 September, 2017.
Jylling Erik, Moving Measurement into Action – Moving from accreditation to an improvement approach, PowerPoint Presentation, Danish Regions.
McDonald, Kathryn, and others, Measures of Patient Safety Based on Hospital Administrative Data - The Patient Safety Indicators, Agency for Healthcare Research and Quality (US), 2002 (Technical Reviews, No. 5.).
Murphy, Daniel R, and others, Application of electronic trigger tools to identify targets for improving diagnostic safety, BMJ Qual Saf 2019;28:151–159.
Sammer, Christine, and others, Developing and Evaluating an Automated All-Cause Harm Trigger System, The Joint Commission Journal on Quality and Patient Safety 2017.
Marlena Shin and others, Examining the Validity of AHRQ's Patient Safety Indicators (PSIs): Is Variation in PSI Composite Score Related to Hospital Organizational Factors?. Medical care research and review : MCRR. 71. 10.1177/1077558714556894.
Measure Sets and Measurement Systems. National Quality Forum.
Singh, Hardeep, The global burden of diagnostic errors in primary care, BMJ Qual Saf 2017;26:484–494.
Singh, Hardeep and Dean F. Sittig, Advancing the science of measurement of diagnostic errors in healthcare: the Safer Dx framework, BMJ Qual Saf 2015;24: 103–110.
Singh, Hardeep and Dean F. Sittig, Measuring and improving patient safety through health information technology: The Health IT Safety Framework, BMJ Qual Saf 2016;25: 226–232.
Vincent, Charles, and others, The Measurement and Monitoring of Safety, Health Foundation, 2013.
Vincent, Charles and others, Safety measurement and monitoring in healthcare: a framework to guide clinical teams and healthcare organisations in maintaining safety, BMJ, Qual Saf, 2014,
Vincent, Charles and René Amalberti, Safer Healthcare: Strategies for the Real World, Springer International Publishing, 2016.
Vincent, Charles and René Amalberti, Safety in Healthcare is a Moving Target, BMJ Journals, Volume 24, Issue 9.
Wachter, Robert M, Patient Safety at Ten: Unmistakable Progess, Troubling Gaps, Health Affairs 29, No 1 (2010): 165-173.
The program can be downloaded here.