Risk-Based Patient Safety Metrics

Patient safety programs require meaningful metrics. Dominant frameworks are based on two safety metrics: one that seeks to identify, measure, and eliminate error and one that seeks to identify, measure, and eliminate injuries. However, non-health care safety programs suggest a third framework, hazardor risk-based measurement. Error measurement has many limitations, including the issues of error identification, hindsight bias, outcome-based judgment, and reinforcement of blame. Although injury-based metrics might aid the prevention of harm, limitations include poor discrimination of preventability, resulting in misdirected interventions, missed opportunities, and disregard for the systems-based nature of unsafe health care. In contrast, work in safety science allows for a third framework: risk-based patient safety metrics that are consistent with systems thinking in health care. These metrics focus on identifying the underlying hazards or risks in the system that ultimately lead to errors and injuries. In this article we explore the strengths and limitations of these frameworks and describe a practical application of risk-based patient safety metrics.