In this presentation, Jonathan Riddell Bamber looks at a new proposed framework to help answer the question 'how safe is care today?' The framework is from a report by Charles Vincent, Susan Burnett and Jane Carthey of Imperial College London, commissioned by the Health Foundation. The framework highlights 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. The Health Foundation is exploring how to develop and adapt the framework discussed in this presentation.we are seeking the thoughts and insights of a wide range of stakeholders – including those with a specialist role in patient safety, those involved in direct care delivery, patients and carers and the public in general. If you would like to share your thoughts, please complete our response form at https://www.surveymonkey.com/s/safetymeasurement or email measurement@health.org.uk by 1 July 2013. The form includes the following questions: Does the framework in this report reflect your experience of healthcare? Are there other dimensions of safety and how would this framework relate to them? Would using this framework make it easier for you to know whether care is safe? Please tell us how you could use this framework. What do you think needs to be done to help you use the framework in practice? How could the intelligence from the framework be used to improve care? We will share what we learn widely to help those involved in patient safety work. We will also use the responses to help develop our thinking about how to improve patient safety.

1. The measurement and
monitoring of safety
Jonathan Riddell Bamber
Research Manager

2. Why measuring and
monitoring of safety is
important
The measurement and monitoring of safety
2
 We measure a lot, but...
- are patients any safer than they were 10 years ago?
- is your organisation safer than it was last year?
 Different facets, different perspectives
- harm, error, reliability, resilience, other indices?
 Focus on how harmful our systems have been, not how safe our systems are
- moving to prospective safety management.

3. Commissioning
The measurement and monitoring of safety
3
 Currently measuring safety
 Tools and approaches to measuring safety
 Positively illustrate a potential future

4. Methods
The measurement and monitoring of safety
4
 Literature reviews
 Interviews with senior staff in national
organisations
 11 case studies with healthcare organisations
in the UK and USA

5. How do we know care is
safe?
The measurement and monitoring of safety
5
1. Has patient care been safe in the past?
2. Are our clinical systems and processes reliable?
3. Is care safe today?
4. Will care be safe in the future?
5. Are we responding and improving?

6. Framework
The measurement and monitoring of safety
6
Past harm
Reliability
Sensitivity to
operations
Anticipation
and
preparedness
Integration
and learning

7. Framework
The measurement and monitoring of safety
7
Past harm
Reliability
Sensitivity to
operations
Anticipation
and
preparedness
Integration
and learning
Has patient care been
safe in the past?

8. Framework
The measurement and monitoring of safety
8
Past harm
Reliability
Sensitivity to
operations
Anticipation
and
preparedness
Integration
and learning
Has patient care been
safe in the past?
Are our clinical systems
and processes reliable?

9. Reliability
The measurement and monitoring of safety
9
 Defined as ‘failure free operation over time’
 How safe are clinical systems? Dean-Franklin et al. (2010), Health Foundation
- 81% and 87% reliability
- 15% missing information
- 6% exposed to risk
 Much being done in isolation, but ‘whole system’ reliability still a challenge
 Identify safety critical processes and behaviours across a system and specify levels
expected

10. Framework
The measurement and monitoring of safety
10
Past harm
Reliability
Sensitivity to
operations
Anticipation
and
preparedness
Integration
and learning
Has patient care been
safe in the past?
Is care safe today?
Are our clinical systems
and processes reliable?

11. Framework
The measurement and monitoring of safety
11
Past harm
Reliability
Sensitivity to
operations
Anticipation
and
preparedness
Integration
and learning
Has patient care been
safe in the past?
Is care safe today?Will care be safe in the future?
Are our clinical systems
and processes reliable?

12. Framework
The measurement and monitoring of safety
12
Past harm
Reliability
Sensitivity to
operations
Anticipation
and
preparedness
Integration
and learning
Has patient care been
safe in the past?
Is care safe today?Will care be safe in the future?
Are our clinical systems
and processes reliable?
Are we responding and
improving?

13. Integration and learning
The measurement and monitoring of safety
13
 How do you integrate a wealth of information meaningfully?
 Different levels, different needs e.g. Clinical Unit c.f. Board
 Not just integration: analysis, learning, feedback and action

14. 10 Guiding Principles
The measurement and monitoring of safety
14
1. A single measure of safety is a fantasy
2. Safety monitoring is critical and needs more recognition
3. Anticipation and proactive approaches to safety are important
4. Focus more on analysis and learning of integrated information
5. Map safety measurement and monitoring across the organisation
6. A blend of externally required metrics and local development
7. Clarity of purpose is needed when developing safety measures
8. Empowering and devolving responsibility for the development and monitoring
of safety metrics is essential
9. Collaboration between regulators and the regulated is critical
10. Beware of perverse incentives

15. What is your
organisation’s approach?
The measurement and monitoring of safety
15
Past harm
Reliability
Sensitivity to
operations
Anticipation
and
preparedness
Integration
and learning

16. Reflections from the
Health Foundation
The measurement and monitoring of safety
16
 Key components of a safe system
 We recognise the need for adaptation and customisation for different
audiences and settings
 Life gets in the way - context matters
 Different approaches for an organisation compared with a patient pathway or
a population

17. Thank you
The measurement and monitoring of safety
17
Centre for Patient Safety and Service Quality (CPSSQ)
Professor Charles Vincent, Susan Burnett, Dr Jane Carthey
Dr Alex Almoudaris, Dr Jonathan Benn, Dr Rachel Davies, Dr Anna Pinto,
Dr Stephanie Russ
The Health Foundation
Professor Nick Barber, Dr Jane Jones, Dr Elaine Maxwell
Advisory Board
Dr Mike Durkin, Dr Chris Jones, Dr Suzette Woodward, Dr Christine
Goeschel, Dr Eamonn Breslin, Dr Jo Bibby, Julie Hendry, Helen
Crisp, Margaret Goose, Dr Tim Draycott