Case study 8: Patient measure of safety
Global State of Patient Safety 2023
Country where the case study originated highlighted in red. Where relevant, additional countries where this programme has been implemented are highlighted in blue.
What is it?
The Patient Measure of Safety (PMOS) captures patients’ experiences of the safety of the care they receive during a hospital stay. The tool enables patients to give feedback on their care, and supports staff to diagnose safety problems to target improvement efforts, as well as identify any areas of excellence.
PMOS is made up of questions covering topics including perceptions of communication and teamworking, organisation and care planning, and ward type and layout. Patients are asked to give responses to questions using a five-point response scale, ranging from ‘strongly disagree’ to strongly agree’.
The tool has been translated into many languages and has been adopted internationally. A version of PMOS has also been developed for use in primary care.
Why was it developed?
PMOS was developed following recognition that patients and carers play an essential role in monitoring safety but are often an underused resource, and they offer a unique perspective on patient safety not routinely captured through other established methods of reporting or incident detection.
PMOS was originally developed as a 44-item measure, but has since been developed into shortened, validated versions, consisting of both 30 and 10 items, to ease some of the challenges associated with its use in routine care.
How can it be adopted?
The researchers are supportive of teams adopting the version of the tool that will be most helpful to them to meet their own patient safety ambitions:
“For teams that wish to use it as a diagnostic tool, it’s important to use the 44 item version… for teams that wish to use it to assess safety… [they] can probably use the 10-item version… because it correlates very strongly with the full version. So, as a measure of safety, it’s [the 10 item version] actually very efficient [and] provides a good overview… it will reduce patient burden and it will reduce the amount of time it will take staff to input the data, interpret it and analyse it.”
It is also recommended that PMOS is administered by somebody independent from the care team, such as a researcher or volunteer:
“…when we were developing the measure, patients said, ‘If a nurse or a doctor or anybody else who's caring for me, approached me with this questionnaire, I wouldn't want to answer it. Because they're caring for me and I don't want to give them negative feedback about the care that I'm receiving… I don't want to be that difficult patient’.”
An intervention called PRASE (Patient Reporting and Action for a Safe Environment) has been developed for use alongside PMOS, to help teams use the safety concerns raised by patients to guide safety improvement priorities. Experience has shown that teams that retain fidelity to the PRASE intervention, and engaged with it the most, were able to demonstrate significant improvements in patient safety.
How can the measurement of patient safety be improved?
“We’ve got a lot further to go with patient feedback, and how we use patient stories and experiences of services. Some of the most interesting things for me are when patients tell me what did and didn’t work, or how care wasn’t joined up, which meant they ended up back in hospital… and we’re just not capturing that in any of the measures that we use.”
Key resources and contact details
Developing a patient measure of safety
Professor Rebecca Lawton: R.J.Lawton@leeds.ac.uk
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