Session 622


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


  • Challenges of measurement: What are the unintended consequences and limitations of current measurement practices? How do these vary around the globe? What are the potential unintended consequences of a new framework for measurement, and how might they be mitigated?
  • The role of proactive and reactive measurement: What are the benefits of proactive data and reactive data? How can each type of measure be used to understand and address both harm and risk? How and when should each type of measure be used, and how can these measures be most useful to systems, clinicians, and patients?
  • The role of patients: What is the role of patients in measurement? What role can and should patient-reported measures play in measuring harm and system safety?
  • The role of novel methods of data collection: How do organizations and countries around the globe collect data (e.g. electronic health records, chart reviews, or administrative data) for measuring safety and/or harm? How can new technologies, big data, artificial intelligence, or other innovations be best developed and implemented to promote improved measurement for learning?
  • Measuring across the continuum of care: What types of measures matter in settings outside of hospitals, such as ambulatory practices, community-based and home health, nursing homes, etc. and as the patient journeys through the health care system? How does collection and analysis of data vary across these environments, and how can a potential framework reduce these challenges?
  • Measures for the broader definition of harm: What measures should be considered to cover a broader definition of harm (e.g., emotional harm and disrespect)? How can organizations measure the psychological safety of patients? How should organizations measure the both the physical and psychological safety of staff and clinicians?
  • National and international action to advance measurement: What are countries doing around the world? What national or international protocols are in place or necessary to develop and validate measures? How can a framework influence developers and processes around the globe? What policies and incentives currently exist, and which could or should be considered?


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.


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.


This program will seek to create:

  • A consensus paper outlining recommendations for a framework focused on improving measurement of safety and harm for learning, improvement, and accountability;
  • Principles for evaluating the actionability and effectiveness of existing measures and the development of new measures for system safety;
  • Recommendations for implementing the framework and selecting valuable measures for health care providers and systems; and
  • An ongoing collaboration among participants and their institutions, including policymakers, to implement the recommendations and improve tools and guidelines for measurement.


Issue One (Friday, September 6, 2019)

Issue Two (Sunday, September 8, 2019)

Issue Three (Tuesday, September 10, 2019)

Issues One, Two, and Three

Virtual Library

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.

Program Agenda

The program can be downloaded here.