Framework for Patient Safety Research and Improvement

Lapses in patient safety represent a significant global problem that results in preventable morbidity, mortality, and costs of care. In the 1999 landmark report To Err Is Human , the Institute of Medicine shocked the healthcare industry with estimates that up to 98 000 people die because of medical errors each year in the United States.1 This glaring report was amplified by a 2003 RAND study that suggested that hospitalized patients in the United States on average receive only half the recommended therapies.2 The impact of these reports damaged consumer confidence in the healthcare industry and galvanized broad industry support to improve patient safety.Five years after the Institute of Medicine publication, there was increasing concern that little measurable progress had been made to improve patient safety.3–5 Since then, the number of quality- and safety-related activities has grown steadily, but there is still minimal empiric evidence demonstrating progress.Our inability to evaluate progress toward improving patient safety results from poorly articulated safety improvement goals and measures and the absence of a simple yet meaningful framework to identify and prioritize the most effective and efficient patient safety interventions. The present report presents a framework to help organize future patient safety research and improvement efforts.We sought to develop a framework for patient safety research and improvement that would address many issues emerging from an expanding international appetite for higher-quality and safer care. We acknowledge that the boundaries between safety and the broader concept of quality remain poorly defined. As we developed and revised this framework, we reflected on our experiences, revisited the Institute of Medicine’s strategies for improvement, and studied the literature on knowledge transfer and diffusion of innovation.6–14 The framework presented includes the following 5 domains (Table 1): (1) evaluating progress in patient safety; (2) translating …