Towards an International Classification for Patient Safety: a Delphi survey.
OBJECTIVE
Interpretation and comparison of patient safety information have been compromised by the lack of a common understanding of the concepts involved. The World Alliance set out to develop an International Classification for Patient Safety (ICPS) to address this, and to test the relevance and acceptability of the draft ICPS and progressively refine it prior to field testing.


METHODS
Two-stage Delphi survey. Quantitative and qualitative analyses informed the review of the ICPS.


METHODS
International web-based survey of expert opinion.


METHODS
Experts in the fields of patient safety, health policy, reporting systems, safety and quality control, classification theory and development, health informatics, consumer advocacy, law and medicine; 253 responded to the first round survey, 30% of whom responded to the second round.


RESULTS
In the first round, 14% felt that the conceptual framework was missing at least one class, although it was apparent that most respondents were actually referring to concepts they felt should be included within the classes rather than the classes themselves. There was a need for clarification of several components of the classification, particularly its purpose, structure and depth. After revision and feedback, round 2 results were more positive, but further significant changes were made to the conceptual framework and to the major classes in response to concerns about terminology and relationships between classes.


CONCLUSIONS
The Delphi approach proved invaluable, as both a consensus-building exercise and consultation process, in engaging stakeholders to support completion of the final draft version of the ICPS. Further refinement will occur.
Thomson
Richard
R
Institute of Health and Society, Newcastle University Medical School, Newcastle upon Tyne, UK. richard.thomson@ncl.ac.uk
Lewalle
Pierre
P
Sherman
Heather
H
Hibbert
Peter
P
Runciman
William
W
Castro
Gerard
G
D003210:Concept Formation; D003695:Delivery of Health Care / Q000592:standards; D003697:Delphi Technique; D007391:International Cooperation; D019300:Medical Errors / Q000517:prevention & control; D017751:Safety Management / Q000145:classification*; D011795:Surveys and Questionnaires