With the launch of Safer Healthcare Now! in 2005, the Canadian Patient Safety Institute introduced the importance of measurement to the science of patient safety based on Peter Drucker's often quoted statement:
"If you can't measure it, you can't manage it"
Over the ensuing years, Safer Healthcare Now!, came to recognize that although our ultimate goal may be to achieve specific improvement targets defined by outcome measures, it was necessary to identify the steps in a process that lead to the desired outcome. These process measures form the foundation of the improvement journey, particularly, as a practice guide for those at the frontline of healthcare. While monitoring the process improvement and outcomes, balancing measures, that is, ensuring that improvement in one area is not causing new problems in other parts of the system, must also be concurrently monitored.
Among the measurement issues that became evident during the evolution of Safer Healthcare Now! and are still true today include:
- frontline staff may collect and submit improvement data yet they rarely receive feedback on their progress;
- healthcare providers don't always use their performance results to guide their improvement efforts;
- one data point at goal does not equate with sustained improvement; and
- if you stop monitoring when you reach your goal, your improvement gains are frequently lost.
In Canada, as in the UK and US, the focus of governments on assessing both quality and safety has increased over the past 10 years. Although a large number of quality outcomes have been specified, the approach to safety has been much narrower, leaving many aspects of safety unexplored. The measurement of harm, so important in the evolution of patient safety, has been largely neglected and there have been prominent calls for improved measures. There is a critical need for patient safety measurement at the frontlines, so that clinical teams can focus on key problems.
Dr. Don Berwick stated in his review of the Mid Staffordshire NHS Foundation Trust, that 'most health care organizations at present have very little capacity to analyse, monitor, or learn from safety and quality information. This gap is costly and should be closed'. There is no one authoritative source of data on patient safety and no single measure.
In 2013, Professors Charles Vincent, Susan Burnett and Jane Carthey published their report, The Measurement and Monitoring of Safety, which describes their framework designed to close the gap identified by Berwick. The conceptual model provides a broader view of the information needed to create and sustain safer care and recognizes there is no single measure of safety. Vincent et al. identified five areas of measurement that are informed by five key questions:
- Past harm (Has patient care been safe in the past?);
- Reliability (Are our clinical systems and processes reliable?);
- Sensitivity to operations (Is care safe today?);
- Anticipation and preparedness (Will care be safe in the future?); and,
- Integration and learning (Are we responding and improving?).
The 'Measurement and Monitoring of Safety' model has been introduced in a demonstration project to eight teams from seven organizations, representing five provinces in Canada. These teams have reported that it has moved them away from "…meaningless measurement and data collection to a more fluid and dynamic approach to safety." Working with coaches, they have learned to change their focus from the absence of harm, to the presence of safety, that is, just because a patient has not experienced harm does not mean their care delivery has been safe – it may simply mean they have been lucky.
Applying both quantitative measures and qualitative data helps healthcare providers move from assurance to inquiry. Using the Measurement and Monitoring of Safety conceptual model to guide your safety conversations and observations is as important as the measures you use. Ultimately, this approach will move healthcare beyond simply measuring the number of harms incurred because safe healthcare is more than just a number.
This blog post was compiled by Anne MacLaurin, Patient Safety Improvement Lead and Virginia Flintoft, Manager, Central Measurement Team.