A New Era for Safety Measurement

Introduction

Wachter (2008) attributes the modern patient safety movement to the publication of the Institute of Medicine (IoM) report “To Err is Human: Building a safer healthcare system” (Institute of Medicine, 1999). This report brought together the findings of the first two large scale attempts to quantify medical error in healthcare (Brennan et. al., 1991; Leape et. al., 1991). The IoM report, using the data of these two studies, equated the death rate resulting from medical error to the crashing of two jumbo jets a day, which prompted global responses. Healthcare organisations worldwide embarked upon similar studies to quantify their medical error rate (Wilson et. al., 1995; Vincent et. al., 2001; Baker et. al., 2004; Soop et. al., 2009; Zegers et. al., 2009) and drew similar conclusions: the rate of error was simply unacceptable and patient safety improvement efforts ensued. The instigation of the patient safety movement may have resulted from this report, but the methodology and conclusions it presented are not without criticism. The research community has responded to these criticisms by attempting to address them. Despite the academic and indeed professional response, the measurement of safety has room for improvement. And safety is written tentatively because as will be explored in this chapter, doubt is presented over whether what is measured is safety, or simply components of safety.

As life expectancies increase and populations age, further burden is placed on healthcare systems to meet the demands of the long term sick, elderly and frail. To meet these demands during times of economic crisis, governments and organisations seek to revolutionise the care model from one of expensive secondary care dependency to cheaper, primary and community care, particularly home care. The evolving care model has resulted in system alterations including: changing stakeholder responsibilities; reduced healthcare organisation control and influence; and greater emphasis on patient participation. In a care model that is driven by improving quality of life rather than achieving health, are clinically driven, disease independent indicators of safety appropriate?

This chapter begins by discussing the state of the art of current systems thinking in patient safety, followed by an exploration of what patient safety means and its associated lexicon. Once a common understanding has been achieved, it investigates tools for safety measurement, critically reviewing their fitness for purpose in their original context. Succeeding this, the evolving care model is introduced and the appropriateness of the tools in this new context is discussed. Finally, we identify gaps in the research and how these might be addressed. We begin with an understanding of patient safety.