Identifying unintended consequences of quality indicators: a qualitative study.

Helen E Lester; Kerin L Hannon; Stephen Campbell

Study

Identifying unintended consequences of quality indicators: a qualitative study.

December 14, 2011

Lester HE, Hannon KL, Campbell S. BMJ Qual Saf. 2011;20(12):1057-61.

View more articles from the same authors.

This qualitative study conducted with focus groups of British general practitioners identified four potential unintended consequences of new quality measures: measure fixation (overemphasis of specific aspects of care), tunnel vision (missing important contextual information due to focusing on measures), misinterpretation of metrics, and potential for gaming measurements to inflate achievement.

PubMed citation

Available at

Related Resources From the Same Author(s)

Tools for primary care patient safety: a narrative review.

November 26, 2014

Trust, temporality and systems: how do patients understand patient safety in primary care? A qualitative study.

February 25, 2015

Systematic review of patient safety interventions in dentistry.

December 9, 2015

Involving patients and carers in patient safety in primary care: a qualitative study of a co-designed patient safety guide.

February 15, 2023

The association between culture, climate and quality of care in primary health care teams.

July 11, 2007

Sensemaking and the co-production of safety: a qualitative study of primary medical care patients.

January 27, 2016

Managing diagnostic uncertainty in primary care: a systematic critical review.

August 23, 2017

Impact of computerized physician order entry alerts on prescribing in older patients.

March 25, 2015

Influences on the adoption of patient safety innovation in primary care: a qualitative exploration of staff perspectives.

August 22, 2018

The effectiveness of electronic differential diagnoses (DDX) generators: a systematic review and meta-analysis.

March 30, 2016

Never events in UK general practice: A survey of the views of general practitioners on their frequency and acceptability as a safety improvement approach

December 11, 2019

In situ simulation: a method of experiential learning to promote safety and team behavior.

June 4, 2008

Didactic and simulation nontechnical skills team training to improve perinatal patient outcomes in a community hospital.

August 10, 2011

Preventable medication harm across health care settings: a systematic review and meta-analysis.

February 17, 2021

Patient safety in marginalised groups: a narrative scoping review

March 4, 2020

Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis.

July 31, 2019

Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study.

October 21, 2020

Frequency and nature of potentially harmful preventable problems in primary care from the patient's perspective with clinician review: a population-level survey in Great Britain.

September 26, 2018

Identifying 'avoidable harm' in family practice: a RAND/UCLA Appropriateness Method consensus study.

November 13, 2019

Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting.

March 11, 2009

Family-centered multidisciplinary rounds enhance the team approach in pediatrics.

April 15, 2009

"Excuse me": teaching interns to speak up.

August 28, 2013

Potential utility of data-mining algorithms for early detection of potentially fatal/disabling adverse drug reactions: a retrospective evaluation.

May 4, 2005

Ambulatory patient safety. What we know and need to know.

March 6, 2005

Retrospective evaluation of a computerized physician order entry adaptation to prevent prescribing errors in a pediatric emergency department.

October 22, 2008

Building a Patient Safety Toolkit for use in general practice.

July 20, 2016

Specimen labeling errors in surgical pathology: an 18-month experience.

October 27, 2010

Increasing reporting of adverse events to improve the educational value of the morbidity and mortality conference.

November 28, 2012

Impact of participation in the California Healthcare-Associated Infection Prevention Initiative on adoption and implementation of evidence-based practices for patient safety and health care–associated infection rates in a cohort of acute care general hospitals.

October 3, 2012

Defining avoidable healthcare-associated harm in prisons: a mixed-method development study.

April 19, 2023

Delayed workup of rectal bleeding in adult primary care: examining process-of-care failures.

January 18, 2017

Quality of handoffs in community pharmacies.

May 10, 2017

Extraneous tissue a potential source for diagnostic error in surgical pathology.

January 4, 2012

Evaluation of patient safety culture in community pharmacies.

February 7, 2018

Professional values and reported behaviours of doctors in the USA and UK: quantitative survey.

April 6, 2011

Unleash the power of patients to make care safer around the world: an essay by Helen Haskell.

September 25, 2019

The problem with preventable deaths.

December 9, 2015

Safety in obstetric critical care.

August 20, 2008

Embedding quality improvement and patient safety at Liverpool Women's NHS Foundation Trust.

May 9, 2007

Medication accuracy in electronic health records for microbial keratitis.

June 12, 2019

Nurse's Achilles Heel: using big data to determine workload factors that impact near misses.

April 14, 2021

Personal nursing care experiences provide lessons on patient safety.

August 17, 2011

The effectiveness of inking needle core prostate biopsies for preventing patient specimen identification errors: a technique to address Joint Commission patient safety goals in specialty laboratories.

February 25, 2009

Incidence, origins and avoidable harm of missed opportunities in diagnosis: longitudinal patient record review in 21 English general practices.

June 30, 2021

Implementing bedside handoff in the emergency department: a practice improvement project.

January 23, 2019

Patient safety rounds: description of an inexpensive but important strategy to improve the safety culture.

January 31, 2007

Psychometric properties of the AHRQ Community Pharmacy Survey on Patient Safety Culture: a factor analysis.

May 11, 2016

Sued for misdiagnosis? It could happen to you.

October 13, 2010

The application of Aronson's taxonomy to medication errors in nursing.

October 20, 2010

Using preprinted medication order forms to improve the safety of investigational drug use.

June 7, 2006

Work effort, readability and quality of pharmacy transcription of patient directions from electronic prescriptions: a retrospective observational cohort analysis.

March 31, 2021

Comparing the variability of ingredient, strength, and dose form information from electronic prescriptions with RxNorm drug product descriptions.

August 31, 2022

Standardized orders for titrating vasopressors: do efforts to improve safety slow delivery of care?

September 11, 2019

All consumer medication information is not created equal: implications for medication safety.

April 19, 2017

Saving lives by studying deaths: using standardized mortality reviews to improve inpatient safety.

August 31, 2011

Hospice diagnosis: polypharmacy—a teachable moment.

October 7, 2015

The gaps in specialists' diagnoses.

April 11, 2018

Quality, safety, and outcomes in anaesthesia: what's to be done? An international perspective.

December 20, 2017

Acute clinical deterioration and consumer escalation: the understanding and perceptions of hospital staff.

August 31, 2022

Exploratory analyses of the "failure to rescue" measure: evaluation through medical record review.

August 6, 2008

Governing the quality and safety of healthcare: a conceptual framework.

May 30, 2018

Twelve tips for embedding human factors and ergonomics principles in healthcare education.

December 13, 2017

Medication reconciliation: reducing risk for medication misadventure during transition from hospital to assisted living.

November 27, 2013

Human cognition and the dynamics of failure to rescue: the Lewis Blackman case.

May 22, 2013

Misdiagnosis: analysis based on case record review with proposals aimed to improve diagnostic processes.

September 7, 2011

Understanding how rapid response systems may improve safety for the acutely ill patient: learning from the frontline.

October 19, 2011

Why don't nurses consistently take patient respiratory rates?

July 2, 2014

Caregiver perspectives on safety in home dementia care.

February 6, 2008

Approaches to improving patient safety in integrated care: a scoping review.

June 14, 2023

Quality improvement and patient care checklists in intrahospital transfers involving pediatric surgery patients.

March 7, 2012

Distraction and interruption in anaesthetic practice.

January 23, 2013

Hospital credentialing and privileging of surgeons: a potential safety blind spot.

April 15, 2015

Post event debriefs: a commitment to learning how to better care for patients and staff.

January 13, 2016

Lack of standardisation between specialties for human factors content in postgraduate training: an analysis of specialty curricula in the UK.

September 2, 2015

Trends in survival after in-hospital cardiac arrest during nights and weekends.

February 7, 2018

A quality improvement initiative to reduce safety events among adolescents hospitalized after a suicide attempt.

May 15, 2019

Implementing a warm handoff between hospital and skilled nursing facility clinicians.

September 18, 2019

Building safer systems through critical occurrence reviews: nine years of learning.

November 10, 2010

An observational study of changes to long-term medication after admission to an intensive care unit.

December 6, 2006

Profiles in patient safety: a "perfect storm" in the emergency department.

June 20, 2007

Research designs for studies evaluating the effectiveness of change and improvement strategies.

March 6, 2005

An integrative review exploring the perceptions of patients and healthcare professionals towards patient involvement in promoting hand hygiene compliance in the hospital setting.

September 12, 2018

Philosophy of science and the diagnostic process.

July 17, 2013

Email for communicating results of diagnostic medical investigations to patients.

October 10, 2012

The role of patients and their relatives in 'speaking up' about their own safety—a qualitative study of acute illness.

July 8, 2015

Reducing risks in complex care transitions in rural areas: a grounded theory.

March 22, 2023

Understanding the factors influencing implementation of a new national patient safety policy in England: lessons from 'Learning from Deaths'.

May 18, 2022

Assessment of opioid prescribing practices before and after implementation of a health system intervention to reduce opioid overprescribing.

October 31, 2018

Leveraging a safety event management system to improve organizational learning and safety culture.

March 30, 2022

Discussion of medical errors in morbidity and mortality conferences.

March 6, 2005

How is safety climate measured? A review and evaluation.

October 20, 2021

Patient safety in community dementia services: what can we learn from the experiences of caregivers and healthcare professionals?

February 15, 2017

Relationship between occurrence of surgical complications and hospital finances.

April 24, 2013

Expanding what we know about off-peak mortality in hospitals.

May 26, 2010

Abandon the term "second victim."

April 10, 2019

Measuring safety in older adult care homes: a scoping review of the international literature.

May 19, 2021

Association of cataract surgical outcomes with late surgeon career stages: a population-based cohort study.

October 24, 2018

A case-controlled study of relatives' complaints concerning patients who died in hospital: the role of treatment escalation/limitation planning.

June 3, 2020

A checklist-based intervention to improve surgical outcomes in Michigan: evaluation of the Keystone Surgery program.

January 28, 2015

Concordance with urgent referral guidelines in patients presenting with any of six ‘alarm’ features of possible cancer: a retrospective cohort study using linked primary care records.

August 10, 2022

Related Resources

Annual Perspective

Patient Safety in the Ambulatory Care Setting

August 5, 2022

Quality improvement priorities for safer out-of-hours palliative care: lessons from a mixed-methods analysis of a national incident-reporting database.

February 6, 2019

Safer prescribing—a trial of education, informatics, and financial incentives.

March 30, 2016

Laboratory test ordering and results management systems: a qualitative study of safety risks identified by administrators in general practice.

March 12, 2014

From physician intent to the pharmacy label: prevalence and description of discrepancies from a cross-sectional evaluation of electronic prescriptions.

February 26, 2014

The PROMISES Project.

February 5, 2014

The costs of developing, implementing, and operating a safety learning system in community practice.

December 11, 2013

The effects of electronic prescribing by community-based providers on ambulatory medication safety.

December 4, 2013

Enhance patient safety by identifying and minimizing risk exposures affecting nurse practitioner practice.

November 20, 2013

Patient Safety Toolkits.

October 30, 2013

Primary care closed claims experience of Massachusetts malpractice insurers.

October 16, 2013

Root cause analysis reports help identify common factors in delayed diagnosis and treatment of outpatients.

August 21, 2013

What patients think doctors know: beliefs about provider knowledge as barriers to safe medication use.

August 14, 2013

The epidemiology of malpractice claims in primary care: a systematic review.

July 31, 2013

Office-based physicians are responding to incentives and assistance by adopting and using electronic health records.

July 24, 2013

Advanced practice nursing students' identification of patient safety issues in ambulatory care.

April 10, 2013

Usability of a computerised drug monitoring programme to detect adverse drug events and non-compliance in outpatient ambulatory care.

March 27, 2013

Certain uncertainties: modes of patient safety in healthcare.

December 19, 2012

Electronic medical record availability and primary care depression treatment.

September 26, 2012

Patient safety perceptions of primary care providers after implementation of an electronic medical record system.

September 12, 2012

Physician patient communication failure facilitates medication errors in older polymedicated patients with multiple comorbidities.

September 12, 2012

Patient Safety: HHS Has Taken Steps to Address Unsafe Injection Practices, but More Action Is Needed.

August 15, 2012

Signal and noise: applying a laboratory trigger tool to identify adverse drug events among primary care patients.

August 1, 2012

Information distortion in physicians' diagnostic judgments.

July 18, 2012

Medication safety in primary care practice: results from a PPRNet quality improvement intervention.

July 11, 2012

Bayesian cohort and cross-sectional analyses of the PINCER trial: a pharmacist-led intervention to reduce medication errors in primary care.

June 27, 2012

Cognitive errors and logistical breakdowns contributing to missed and delayed diagnoses of breast and colorectal cancers: a process analysis of closed malpractice claims.

June 13, 2012

Prescribers' interactions with medication alerts at the point of prescribing: a multi-method, in situ investigation of the human–computer interaction.

June 6, 2012

Investigating the Prevalence and Causes of Prescribing Errors in General Practice: The PRACtICe Study.

May 16, 2012

A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis.

March 7, 2012

See More About The Topic

Ambulatory Care

Health Care Executives and Administrators

Policy Makers

Family Medicine

Primary Care

Identifying unintended consequences of quality indicators: a qualitative study.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Identifying unintended consequences of quality indicators: a qualitative study.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

PSNet Log in

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site