• ‘Proactive Risk Monitoring in Healthcare’ (PRIMO) began as a project in our Safer Clinical Systems (SCS) programme
  • Is a tool for risk management that aimed to complement existing methods by plugging the gaps in risk management strategies and procedures.
  • From June 2009 to December 2010 the PRIMO process was co-designed and tested in the dispensary at Hereford before being tested more widely in diverse health care settings.
  • Funded by the Health Foundation with technical support provided by Mark-alexander Sujan at the University of Warwick.

PRIMO was designed to complement the tools available at the time for assessing risk within a complex health care system, and to challenge the negative beliefs around incident reporting. PRIMO sought to improve the effectiveness of risk management and incident reporting as a method of learning, to reduce the risk of patient harm.

It allows an organisation to assess the amount of control it has over processes such as communication or training that often create weakness in the system (latent conditions), and can contribute to adverse events. Latent conditions are the result of organisational deficiencies that are under our control and can be changed.

PRIMO aimed to discover and analyse information, but also attempt to create a strong local safety culture by including staff as well as managers, and giving timely feedback that has obvious relevance for the local work environment. The most common Basic Problem Factors (BPF) were selected for ongoing monitoring, and rated in terms of the amount of hassle they cause to staff during a specific period of time, using a questionnaire. This established how likely the BPF was to be contributing to latent conditions.

PRIMO encouraged front line staff to own this process, and aimed to create a stronger safety culture. It used narratives, a questionnaire, a visible action plan and the concepts of safety space and safety time to create a risk profile and engage staff in a positive action plan for safety improvement.

The PRIMO tool more was tested more widely in diverse health care settings. This work focused on identifying key factors for successful implementation, refining the tool and assessing the impact of the tool on staff.