title: How will we know patients are safer? An organization-wide approach to measuring and improving safety.
abstract: OBJECTIVE
  Our institution, like many, is struggling to develop measures that answer the question, How do we know we are safer? Our objectives are to present a framework to evaluate performance in patient safety and describe how we applied this model in intensive care units.
  
  
  METHODS
  We focus on measures of safety rather than broader measures of quality. The measures will allow health care organizations to evaluate whether they are safer now than in the past by answering the following questions: How often do we harm patients? How often do patients receive the appropriate interventions? How do we know we learned from defects? How well have we created a culture of safety? The first two measures are rate based, whereas the latter two are qualitative. To improve care within institutions, caregivers must be engaged, must participate in the selection and development of measures, and must receive feedback regarding their performance. The following attributes should be considered when evaluating potential safety measures: Measures must be important to the organization, must be valid (represent what they intend to measure), must be reliable (produce similar results when used repeatedly), must be feasible (affordable to collect data), must be usable for the people expected to employ the data to improve safety, and must have universal applicability within the entire institution.
  
  
  METHODS
  Health care institutions.
  
  
  RESULTS
  Health care currently lacks a robust safety score card. We developed four aggregate measures of patient safety and present how we applied them to intensive care units in an academic medical center. The same measures are being applied to nearly 200 intensive care units as part of ongoing collaborative projects. The measures include how often do we harm patients, how often do we do what we should (i.e., use evidence-based medicine), how do we know we learned from mistakes, and how well do we improve culture. Measures collected by different departments can then be aggregated to provide a hospital level safety score card.
  
  
  CONCLUSIONS
  The science of measuring patient safety is immature. This article is a starting point for developing feasible and scientifically sound approaches to measure safety within an institution. Institutions will need to find a balance between measures that are scientifically sound, affordable, usable, and easily applied across the institution.
authors.affiliation: The Johns Hopkins University, Department of Anesthesiology & Critical Care Medicine, USA
authors.forename: Peter
authors.initials: P
authors.lastname: Pronovost
authors.forename: Christine G
authors.initials: CG
authors.lastname: Holzmueller
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
authors.forename: J Bryan
authors.initials: JB
authors.lastname: Sexton
authors.forename: Marlene
authors.initials: M
authors.lastname: Miller
authors.forename: Sean
authors.initials: S
authors.lastname: Berenholtz
authors.forename: Albert W
authors.initials: AW
authors.lastname: Wu
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
authors.forename: Richard
authors.initials: R
authors.lastname: Davis
authors.forename: David
authors.initials: D
authors.lastname: Baker
authors.forename: Laura
authors.initials: L
authors.lastname: Winner
authors.forename: Laura
authors.initials: L
authors.lastname: Morlock
mesh_terms: D005544:Forecasting; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D008962:Models, Theoretical; D005791:Patient Care / Q000592:standards; D010361:Patients; D012449:Safety / Q000592:standards*