Multimethod study of a large-scale programme to improve patient safety using a harm-free care approach.
This study described a multiphase nationwide quality improvement project in the United Kingdom to address four patient safety issues: venous thromboembolism, pressure ulcers, catheter–associated urinary tract infections, and falls. First, investigators developed a single measure of harm-free care that encompassed each of these issues, which was termed the National Health Service (NHS) Safety Thermometer. They reported that implementing the new measurement at health systems was time consuming, labor intensive, and controversial among frontline clinicians. Health systems were then recruited to participate in regional improvement collaboratives that provided in-person guidance on implementing evidence-based practices at three learning events. Attendance at these meetings fell short of expectations, and participants expressed difficulty in translating these aims into local action. The next phase involved giving health systems financial incentives to report their data on harm-free care. Over time, reports of harm-free care increased, but the stated goal of reaching 95% harm-free care was not reached. The authors also noted that structural reorganization of the NHS may have impeded the success of this intervention.