Moving Measurement into Action: Designing Global Principles for Measuring Patient Safety

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

KEY QUESTIONS

• 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?

PARTICIPANT PROFILE

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.

PROGRAM FORMAT

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.

EXPECTED OUTCOME AND IMPACT

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.