In the last decade in the UK there has been a huge volume of data collected on medical error and harm to patients, as well as a number of tragic cases of healthcare failure and a growing volume of government reports on the need to make care safer. Despite this, we still don’t know how safe care really is. Assessing safety by what has happened in the past does not give us the whole picture nor does it tell us how safe care is now or will be in the future.

In The measurement and monitoring of safety, Charles Vincent and colleagues from Imperial College London propose a new framework to help find the elusive answer to the question – how safe is care today?

We hope this report will trigger debate and discussion that will lead to a new way of thinking about patient safety, and shape the safety improvement work of the future.

Five dimensions: a proposed framework

This framework highlights the following five dimensions, which the authors believe should be included in any safety and monitoring approach in order to give a comprehensive and rounded picture of an organisation’s safety:

  • Past harm: this encompasses both psychological and physical measures.
  • Reliability: this is defined as ‘failure free operation over time’ and applies to measures of behaviour, processes and systems.
  • Sensitivity to operations: the information and capacity to monitor safety on an hourly or daily basis.
  • Anticipation and preparedness: the ability to anticipate, and be prepared for, problems.
  • Integration and learning: the ability to respond to, and improve from, safety information.

This framework provides a starting point for discussions about what ‘safety’ means and how it can be actively managed. A diagram of the framework is available to download. There is also a diagram of the framework including suggestions of measures that might be used for each dimension.

Additional patient safety resources

If you’re interested in patient safety then take a look at our dedicated Patient safety resource centre for hundreds of practical tools, materials and downloads.

Further reading

Safety Measurement and Monitoring

The aim of the Safety Measurement and Monitoring programme is to test and develop Professor Charles Vincent and colleagues' measurement and monitoring framework, translating their research into an ...


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