Case study 3: Safety measurement and monitoring framework
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 Safety measurement and monitoring framework (SMMF) resulted from a research study which sought to answer the question, how safe is care today? The framework identified five questions that are necessary to ask to give a complete picture of an organisation’s safety: Has patient care been safe in the past? Are our clinical systems and processes reliable? Is care safe today? Will care be safe in the future? Are we responding and improving?
The framework has been tested and applied in a range of UK contexts, and has been adopted in several countries. It formed the basis for a major improvement programme with 11 organisations in Canada, led by Healthcare Excellence Canada, comprising teaching and on-site coaching support. Evaluation of the programme found that it built the capacity of teams to understand and implement the SMMF in their local settings, translating into a range of different improvement interventions.
Why was it developed?
The original research study was conducted, and resulting framework developed, because, despite the voluminous data collected on incidents and harm in health care, it remained difficult to truly understand how safe care really is. A particular problem was the focus on measuring and monitoring past harm, or lagging indicators, as opposed to information on current and emerging risks, or leading indicators.
The team in Canada had originally undertaken a lot of work to tackle serious, discreet forms of harm (such as central line infections, and ventilator-associated pneumonia), but wished to follow that work up by providing frontline teams with hands-on support to take a broader approach to improving safety.
How can it be adopted?
Healthcare Excellence Canada sought advice from one of the UK teams who had tested the framework, who advised “‘just stop what you’re doing. It’s less to do with the indicators, it’s all in the conversations.’” The programme supported a significant shift in the thinking of the teams, away from conducting individual safety “projects” towards deeper conversations about what is meant and understood by safety in different contexts:
“It's not about projects, and it's not about measuring and counting stuff. It's about transforming people's hearts and minds about what safety is and empowering them, encouraging them, and facilitating them. To take what they know and act.”
A key element to the programme was the use of on-site coaches – “…that’s where the magic happened… challenging the teams to do things they weren’t necessarily comfortable doing”. The facilitation of open and honest conversations then turned to specific problems, that the teams were then empowered to try and address.
Healthcare Excellence Canada has produced a range of resources to showcase their learning and support other teams and countries to adopt the framework. A practical guide has also been produced by the Health Foundation. There are several core principles that the Canadian team have adopted that are used when building understanding of the framework and translating it into action, emphasising that it’s about:
- The conversations, not the projects.
- Curiosity and inquiry, not assurance and accountability.
- Coaching and mentoring, not simply compliance and monitoring.
- Taking a proactive approach, not a rear-view mirror approach, to safety.
- Recognising everyone contributes to patient safety including patients, residents, clients and their care partners.
How can the measurement of patient safety be improved?
“It's about making the people who are delivering care, responsible for safety. They see it and they know the solutions, versus… what we've done historically… is that safety became projects and tasks, policies, compliance, that came from a manager or leader or someone in quality safety and it became tasks that the staff had to do…”
Key resources and contact details
Healthcare Excellence Canada - Presence of Safety
Anne MacLaurin: Anne.MacLaurin@hec-esc.ca
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